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HomeMy WebLinkAbout040-1009-95-000 C N OO N O W c y = N ° v ~ C O ~ N ~ a ° 00 y x c " N N ~ C 0 o Y ~ o I L u c m o m 3 0 ~ .N Q y I v m Z E z a z w m d m M FN-- V) O z c Z ° = Z H N a y N *S = AJ d r c C C Q U ° a ~i z H Z o z N y C I c C 7 > 06 C M w U C a U) (O N d L O GGCL O E N LO F- F H o b N d C 0 0 0 Z o •N aa(L a N Lo in °i U I OOi 0) (D 00 a) O Y O ~ m d O d Q C I' ~ H H ~ I r- E 00 t- O L'0 _ IL a) ol r \ O V = Y Y - N o p - 0 °i c C= a) co co O _ CO M 04 00 a) ~'V r.r N f6 N • ~i O O f- !A N O ,n CQ i E V ✓ kd ~w , E 4) ee #x EL m cm a A 0 a O U-) 0 J: r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ZO"~\ S "t B-R- ADDRESS "v1~~ aCi nom- A ` Js t~.: t S SUBDIVISION / CSM# LOT # D O SECTION T X3 N-R I W, Town of e-5 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v C i t ~e !1 / INDICATE NORTH ARRO Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f BENCHMARK: ALTERNATE BM: SEPTIC TANK / MMR / HO 'INFORMATION Manufacturer: Liquid Capacity: /Q- Sze Setback from: Well ,V House Other Pump: Manufacturer 11/,4- Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length_ c'~10 Number of trenches C? Distance & Direction to nearest prop. line: i Setback from: well:- House .3U Other ELEVATIONS Building Sewer ST Inlet, ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system • > , y C/ Existing Grade q 1k, Final grade DATE OF INSTALLATION: Z PLUMBER ON JOB: l-='- LICENSE NUMBER: /,5 f3 INSPECTOR: rr, 3/93:jt . Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations 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 PI SEIBEL, JOHN X CST BM Elev.: Insp. BM Elev.: Description: Parcel Tax No.: BM o_ 4&4,,7* 0,4 A95003i2 TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Benchmark /Od . Dosing L/ Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 3 8 Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Septic >,25 '010 /8' - NA Dt Bottom /3.83. i 4Y.Sgr Dosing NA Header/Man. ,x.27 ; 46,/3 s.2 4 z' Aeration NA Dist. Pipe ia:vs' 9r, 7xx d.YP~ *SIF s is. 43.Vi 3-v' 4s o, Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade ,o,v 98. Manufacturer Demand r-A, 3. Ls /o y- 7$ Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dist. To well Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 51 o DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of CHAMBER Moe Number: System:LAjZ,pLej), 30 / 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 1 4 ° xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center O`~1 Bed/ Trench Edges Oi O Topsoil E] Yes I-] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.3.28.19W, SE, NW, White Oak Drive Plan revision required? ❑ Yes ► No Use other side for additional information. Gl D$ QS Jqj 17- SBD-6710 (R 05/91) Date ns ctor's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code S-r 0 r STATE SANITARY PEW(r # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑L~ 8% x 11 inches in size. C ec 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. PROPMr, NER PROPERTY LOCATION ` s %NW'/a,S 3T ,N,R )W PROPERTY 'OWNER'S MAILING ADDRESD LOT # BLOCK # 1 TATE _ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUM ER S 01 -7 1 ( 1-3 CITY II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAR~s T OAD TOWN :'C'Ib iv h t~~ Oq1~ Qr. ❑ Public LEJ 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUMBER( 5) III. BUILDING USE: (If building type is public, check all that apply) G 6 6"D 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 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. lb New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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. PE RC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./i h) ELEVATION OD 420-0 15" Feet Feet 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 Holding Tank 1 S O Lift Pump Tank/Si hon Chamber_"__~_ El I Ej F-I FJ El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pprint): Plumber's Signature Stamps) r/MPRSW/No.: Business Phone Number: -3 ^s i 1 O 01.5 Plumber's Address (Street, City, State, Zip Code): [9(09 - 1195-11" IU 1Q_w P l a d S o t IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa 4ary Permit Fee (Includes Groundwater Date Issued gnati a (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) 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 I~ 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. 11. 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) w li 5 ILI I # #1 I ~3vy5 sow Tft.~-t/ EL Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY _ Attach complete site plan on paper not less than 81/2 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. ©'y~' D APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L/ "Z /f U'eP ~ t GOVT. LOT 5E 1 /4 ^/w 1/4,S 3 T LP N,R /F E (or) W PROPERTY OWNER':S MAILING ADDRESS LOS BLOCK # SUBD. NAME OR CSM # /3/~ ffg G C,PEsT I~.~ • CITY, STATE ZIP CODE PHONE NUMBER QCITY QVILLAGE WN NEAREST ROAD vOSo,~ Z0/, Ale . [ New Construction Use [ Residential / Number of bedrooms [ J Addition to existing building j j Replacement [ j Public or commercial describe Code derived dairy flow gpd Recommended design loading rate / bed, gpd/ft2 • -T trench, gpd/(t2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ~ bed, gpd$ ' S trench, gpd1ft2 Recommended infiltration surface elevation(s) SEA - 3 ft (as referred to site plan benchmark) Additional design / site considerations 1l5,C- Parent material 621W1,V dU TIf~A Flood plain elevation, if applicable ft s = Suitable for system CONVENTIONAL M~OUNg IN-GROUND PRESSURE AT-GRADE SYSTEM IN R HOSING TANK U= Unsuitable fors stem G~ O U L4-S Q U 2S Q U 9-S' Q U Q S Lam' SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 10 Y,,d 31Bed Trench S S -f SdK /*1 fe C; 3AIL 13 ~2- 41 - 75 YX //j~ Ground 3 ) - 220 7. .5 Yte 00 elev. /off fL Depth to limiting ' factor L Remarks: Boring # /Dy~P J13 sl 2 fsl,~ f•E' ~s 3,~. . s G - S o, S 7 Ground -4 7S YIP eley., fL Depth to limiting factord Remarks: CST Name:-please Print Phone: Address: //A/v~s~ti S ~/PlG Sgnature: Date: CST Number: Z yy ~sr~ v e Z ORIGINAL PROPERTYOWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. I Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 3 Ll)-/2- ioy/e 3 3 s~/ 2 fs S Saar s -24 i~ Pf}iP T-° F /oy,2313 ~zo Z ,Q 41.,f~e T5 % • 3 Ground 2 1-2 "y~ elev 3 . ft yd - ~ -7 s yie Depth to rs 7/, s`j G! - Jr limiting faCtDr f2ur S D G ,L 7~S - itv v0 < < < 90 1 ?E~'~D J Remarks: sUlrGES7'" 2lS~.;c)G- ~~'Si~.~ /oy►p~-,vim ,P.~T~- of'- , .S• G/~L~/1F•~ Z Boring # o-i o Ye 313 .5V z shy ,e 5 3''^ s -41 2- 4 Yle elev. 9~ Zv. ft. S y/~ y Oo !!le ~S o f S~ f 'Sd,~ ~s . • 5~ Depth W limiting laclorv Remarks: /a,9D i A-? G- /V_f T€ le R Sl 44-e Boring # /e 313 3 S 3,wi Yk xlcle- "M fl d5 Ground 3 % ~s'~,~ y/!P s/ s~✓,(~ W,e > s ~~v elev. _ 7S Joie , s D, s 7 A. yo ft / 7 Depth to " SY/e f S, s~ / Ics~,~ ~S - Y limiting ~t%9wpaq Remarks: Boring # MR Ground elev. tL Depth to limiting factor Remarks: 00n 0,20wo twinn% _ lp : 3 0 3 ifT ovs' r J Tip F.ve,4, /po . y0 ' 9 s~ P = 30 ~ . ~ ~,~o PosED ~ 0 ~ J~1~D.y~Si' TE ~ V I I h ' .4 r cE,tS T 1~ oR Mo~'E l ~ M~ i i I`mo' ~Pb ~ Ih' I~~ Ixl r ~ • 1 1 Ir.l I I l /nn ✓ / tool of Ip ~b I I 1 I 1 I l I j l I j 1 1 iJ j /DD. ZQ ' A l i I I I I /(g •I 1 I l I I - i I• 8, 13 f/ 9PP LO PJJl1 ► I ~ I 135 - (Q ws r 2 ~o 8g . zCo ~ ~ I f----- o gM 5eT. r6 of 3/y P W l r , q _ I J PAGE OF C.r~SS Sec~IUn o~ SYS~en~ Fresh Air Inielc And Obcervallon Pipe J Approved Vent Cop Minimum 12' Above Final Grade 20- 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Mash Hay Or Synthetk Covering Min. 2' Agtlregate Over Pipe Ol~trlbutton pipe o 0 0 0 -T I so ! 6' Aggregate 0 Perforated Pipe Belo vr Beneath Pipe o -Coapting Terminating At Bottom Of System Jam, z Proposed finki grti~1< g 511--iJ ton SOIL. FILL i DISTFCIBUTIOF.7 PIPE • APPROVED SjWPETIC COVER Q" O+F ~6GR EGATE . _ 'c OR ('1AR'SN HAyq,~ OF STRAW e o i e ~.OFlZ-Zt/2 AGGREGATE OF FEET DI.STRIR~,TIOM PIPE TO BE AT LEAST IMCHES BELOW ORIGIAIAL GRADE A►JU AT LEASTZ0 i.MCHES BUT 1.10 MORE THAI) 42. INCHES BELOW FINAL GRADE 1`UUcIMUM DEPTH OF EXCAVATIOP FROM ORI&NAL WEIR WILL BE cp IUC14ES MINIMUM Wr►t of EXCAVATION F.ROIh. 01KI(AWAL C3R40E WILL 8E INCHES SIGUEO: LIC EU SE IJUMBE R: a DATE: W, nsinDepartmentofindustry, SOIL AND SITE EVALUATION REPORT IYAWnd Human Relations Page L of 3 on of safety & 9uitdings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST GIGO/ X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. 0 1/0 •/00 f • F.11 pUp APPLICAO.INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE.. PROPE-OTY OWNER; PROPERTY LOCATION V o N' $a ~i -r.AHM SEA 8 FL- GOVT. LOT SE '114 Nw 1/4,S 3 T 2- N,R E PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK If SUBD.'NAME OR CSM / 1/09 CRA449 1,Al • ,yam s ' 13 0" Jo.s J-07- CITu~AE ZIP CODE PHONE NUMBER []CITY []VILLAGE [a~FOWN NEAREST ROAD o0 5y0l W 1. (71.5) 3.f6 - S 72 I o ; LE 5246K -P#V • [&(New Construction Use (vf Residential ! Number of b6drooms (J Addition to existing building [ ] Replacement (J Public or commercial describe Code derived dally flow foaa gpd o ReconvArided design loading rate bed, gpd/1112 • Strench, gpdM2 Absorption area required bed, 02 12-0 bench, ft2 Maximum design loading rate ~ bed, gpd/ft2 • ✓r bench, gpdfft2 Reoommended infiltration surface elevation(s) 5--e-C P el • 3 It (as referred to site plan benchmark) Additional design/ site considerations use- ?7e&'jj S oAPL - 00 s Go Ar w app _4O-VgPJ Parent material 06'S S O&4R S r1//5* Flood plain elevation, it applicable ft S = Suitable for system i1 IN-GFUND _ 1 U ESSURE AT_GR9DEO U Q S N1 d' Q s TMA( U =Unsuitable for a stem S ❑ U U 01 ❑ U (~•g L}'s[ owl SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench • o -(0 1 o YR 3 Sr'/• 2 4++ shk i►r.~R s •VA s . Z ' /7 /0Yk 3/4( Si/, 2f SA& A"-Fie is Ground 3 7' 5 YR y - S/ S~iC AM • S . etev. AP0. 2. it. Depth to ;lr.;Itl r~y - - - - - (actor Remarks: Boring # . /'W Ile 4171C I 2 Z d • /oYA 41/3 /f 5X- w fie CS sf • 2- . 3 3 - 7.S VA Ground elev. AR 9 7• Y it. Depth to Thft toot site V1W limiting for D r factor Remarks: T Name. Please Print iR T' Phone: ?!5 _ 3,96- tT ~ S5 Address: F ociates -7 1 q- 15 C S7"-Y z yRZ Signature: private sewage Consu I Date: CST Number: i 655 O'Nall Rd. 2~, I Hudson, vvis. b4016 2t!s~' srTE' ~'~i~iE'o v~v ~•%y : pyl oTr iP Qo,;P~- 2rr~ ~ , " / s.ru/~ )G- 741S S/T4- &1,01 / ~rrap To ~r GirT 5T~fir/o.u r4S S 'jj r coRN~QS a~ ~ U irFY f k4V. AY- k-VT a t + , • M ' wW~V O/V440 VOJ ~ :s~laawaa a ' S 1 i J01381 bulllwo W yldap • 71 ~ ~ , ; 'nala ` punols L:Ll # 6ulJo8 . a>Ilewad. j I qW4 # Bu~IWy 01 41dap '11 .Aala punols Ld 1F- # 6ullo8 f)uslwl a wdaa 4 '1) •nala PWaO 13 # 6upoe . • a~lewalr{ JOIA oualwo • 01 41~Q Via pun0jo V/S ua1a1 pa8 4s 'Is .1D stood ~unoe ooualslsuoyj aanlxa J0I°~u103'zS'nO 1!/0 d J Ilesunyy ul alnlon~l8 1 W JoloO lueulwoo 41dao uozlloH # 6U11o8 t'Q'1 l33UVd £ 1° r aged -LUOd3d NOI1dId383(1 BIOS d3NMOA1!l ON f~ SSv y t y Gy 6-S 7- o T- G . - ~o eL o 40-o.ti ~.PS r w N cn w m 70 Z Z Z i ~ m o cn o Lo A -70 1 r r CA o ~ o CIS L rn ~ ° 77 1 N 4 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page/ of 3 Labopand Human Relations Division of Safety & Buildings in accord with I Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x ~n as in size. Plan rnO 'nclude, but ST not limited to vertical and horizontal reference point (B ectio,ar o of slop) a or PAR # ~bO OOp dimensioned, north arrow, and location and distance resi~t / ' ! J APPLICANT.INFORMATION-PLEASE PRINT A INFO'RT REVIEWED BY DATE . I PROPER~~OOWNER: T~4HM S.E; VOW X;~ G RO E CATION ss!! XE 1 /4 NW 1/4,S 3 T 2 N,R 19' E (a( WD PROPERTY OWNER':S MAILING ADDRESS r*4 L LOCK # SUBD. NAME OR CSM # VO.? GEOIR IW- .tip S (3 otter PS o CITYUjP JOw~ Wil. s Moira (7!5) 3S~O ' T PHONE NU []VILLAGE PFOWN NEAREST ROAD New Construction Use [r' Residential /Number of b6drooms [ [ Addition to existing building [ [ Replacement [ I Public or commercial describe ao / 2 .S- r bed trench Code derived dally flow t's> gpd o Recommended design loading ate , gpd/ft , gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 f 20 trench, ft2 Maximum design loading rate / bed, gpol11:2 - 5- Recommended infiltration surface elevation(s) 5-et- P9 • 3 It (as referred to site plan benchmark) Additional design / site considerations 24-SE- Tgff'y S 9,,24,V- v o S Gop G, W/ JW OP ✓8 o X - Parent material 14CS S 10048 S Ti'/ S' Flood plain elevation, if applicable AO~t ft S = Suitable for system CONVENTIONAL Mou D ❑ U IN- CCGRQUND U ESSURE AT-GMDE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S 11 U [~3'$ 'S ❑ 21 ❑ U ❑ S Cam' ❑ S 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 m-nch 13 &P-& ID YR 3 5'1'1. 2,x l flik / &-fR s 4 5 .6. 2 - /7 /aYk 3/4~ 'T 10'e A,,,. -Fie es 3f .5 .C., Ground 3 7' 7.5 YR y Sl S~ie n++ `f • S ' elev. /00. 2. ft. Depth to limiting factor ~T1W_ Remarks: Boring# 0• 20 /oYR 3/i. ~S '1AJf J~e GrA CS 3 .'7 . 2- cs .2 f .2- 3 - 7.5 yie y - S/ 1sk X44" a c lf Ground elev. AR YO it. Depth to / limiting 51 factor Remarks: CST Name:-Please Print RG QerQj- 24 L Q R i C A T_ Phone: 715 _ 3 3( P 64.5 Address: Associates -7 ~ (q- 15 C ST 1 Z y40 > Signature: Private Sewage Consu tan t Date: CST Number: 666 O'Neil Rd. 54016 Hudson, Wis. re doe ~/~-tx,~~r~' Vse' 51AE /}'AI",o 0x5~ F-15-- 7141. oT o i S.fUi,,t~G- 9i5 siTF' tv.// iP~ Qv.;e~ ?rf~ lutr ftk4v.Y- 140 44-~ Y" 4e-=- y k-OT wr ~ Tom` • 4 , PROPERTYOWNER ,5011340-5 SOIL DESCRIPTION REPORT Page ~ of 3 PARCEL I.D. S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourdEsy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch 3 r -1 /o ie 313 Si h" YAe A% fie s j f . S • n. Z -4 /o x 31 5W beSk .t4f C S 3`f . 2- • 3 Ground 3 G _ -7-5 Y9 y S/ / f s4e m f P ~ r `F . ~ . S elev. If.,S;Q ft. Depth to limiting 7facttoor~ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: ` Boring # M J Ground elev. ft. Depth to limiting factor Remarks: con onnnio nci n% . r r a IV) q- o ~1J a; l w .107 -l s V3 (73 Uns;+ v> C4 L ac _ n!~c W o - -V) ~ M 4 - w w w QL 4u !w M r~ 00 ~ l In o I V7 Q ~ W LU Q C 119 -7 40 -7 --Z S307 Cf--_2 "Z •z~ YY~sconsinDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page Labor and Inman Relations _ of Division of Safety a Build(vs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, abut ST C~Oi trot limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # r.. dimensioned, north arrow, and location and distance to nearest road. - - APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER PROPERTY LOCATION GOVT. LOT 5E 114 /Vw1/4,S 3 T 2R ,N,R 4? E (or) W PROPE3RTTYQWNE' g':S MAILING ADDRESS LOT BLOCK fl SUED. NAME OR CSM #I 7- Coo br fTi~ L CiPE5•~ CITY, STATE 21P E PHONE NUMBER FSO' lye/ !o g r z 8~/ OVILLAGE N N WEST ROAD I fNew Construction Use I Residential / Number of bedrooms I I Addition to existing building l 1 Replacement I I Public or commercial describe Code derived daily flow &00 gpd Recommended design loading rate 1 S Absorption area required bed, ft2 trench, 112 Maximum desi n loadi / 9P ' S Vench, gpd/it2 Recormlertded infiltration surface elevation(s) SEA p 3 g rate bed, ;dili trench, gpd/ft2 Additional design / site considerations 4551 ti'-,f ,P~w B (as referred to site plan benchmark) a 6- /P clr_s L4 fzwolo ,Bvk 1111'i15X Parent material /ilc~%!/ oyTll~,4 Flood plain elevation, if applicable : ft S - Suitable for system CONVENTIONAL M-OUN~q IN-GROUND PRESSURE A6T G IE SYSTEM U a Unsuitable for system E'br ❑ U l~ ❑ U 0~ 0 U C~-~ O U 0S SING Tic SOIL DESCRIPTION REPORT Depth Dominant Color Mottles in Munsell Qu. Sz. Cont Color Texture . Structure Consistence tidy Roots GPD/ft Boring # E_7 Gr. Sz. Sh. Bed lerrh /o YA P /M 3'jL L -3 7.5 Y X y ll /~~`i~° CS' . 5 G 1T 0 7.S y Depth to limiting ~ . factor Remarks: Boring # r.9 - "j la XP Y13 J-1 2 fs6f- f.P 4_5* -fl.-I - S . G Z y3o 1s sl 41 . ~i .s 12 Ground 00 elev 'Depth to limiting factor Remarks: TName=Please Print &X4 7- Z11_,3.r1'cA7- Phone: c3Pa-(f fir go/ Signagxe: ~ Date: CSTNumber•_,_._. l l PROPERIYOWNER LIZ /'~V~/~~J SOIL DESCRIPTION REPORT Pte? of 3 PARCEL I.D. i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BojiUy Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mnch 3 12- /DYie 3 3 Si/ 2 .f:s Y s 740 F L?- a 10M 33 3 p~,~ 2 z ,e f~ qs , .3 Ground ,oo tc 3 y~'9 ~Sye y/ - S D, s dl- Depth to 41' s/ 7 sil Gf .S' . - Js limiting Remarks: 2. Boring # -i o ye 313 s-l Z f Sly ~,e s 3~^ , s Z y- fp Ito ye 31s 17'CS4e cr~una ~,SYle s . o, S j. a -e , 01 9~ ft n n a 7,s y~ 00 (eves o f s/ ~7Csd s . 4 Depth m .v G- /-f Y09R S/ 0att-t ~S - Remarks: rt t'F.j~f Boring # -f p Y4 13 - 411 FAA S 33441L S 1 S Z yie y~~e Mf/' Cis 3 ; •4 3 Gland Slav. .,Sy S 49 7sy~ Depth to smiling Remarks: Boring # i GmuW elev. f It. Depth to limiting War Remarks: Qom o.,~„o,u~," 3 of s )66EsT&D sy,5rf,q F/~vilTiov.S esr T,PE,u ~o/ yp ' r w 7i~'Ew ~ 9~ S~ Sc.~- L E ~ ~ _ ~O 0 ~ 17~f/~ Si' TE I V h 1 4 T cE,1 S T 3 oR Mo~E I ~ r i 13, I of Pub 13 z /a y~-o I 133 1,00,20' I , fF 2-0 ~ I~ II s , ~ I II I ' wsr GI ~o fo s/clld E- 83 . ^ ~-eNOe •~..P - ~1'ssv-yEO~? l So~~ tol- ~ . O N ££'80t, - bb •880 U to CD O m I 0 ~t X6 p 5 M I ~n 3 ~ I II ,91•L£9 / "V i I 0 N O ti ~ V 6LL N O L a' es 3 £6'9£9 ,09'Lb9 I 0 Q U O N (0' 0) 0 M U-) O N I ,61'919 £19 / I N ~ O 0 N 0 Ir I N O w (D J M v rf) d o v 0 \ M P- N / ,00 0b£ I ~ C 'CIC - i Q O O 25- GVOY U-) d ~ N 71dbll 3`1y~ 0 ~ N l r aMD -0 W) N - -O %L (Y) ~ c-ti ti ~ o u190 ~ ~ A O~ H LO V L i` - M ,098 -5 6- ~ ~s9 O 00 Zoo O ss9 N F9 W o6 m I -690 rn ~ _ M v ~ Q a0 CA M 30 N \ V O N W 00 m M \ / QO M / N ~N~TE 1 r ✓ `f r ' ~o1~N SE1~~ 1... 1 _ 1 De, dSo ~.1 'To 4%A 0Se N q 4- c_ou r~ P-0 N J aw~iZ tZoo►n 3 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS S`T ~ ~IVN-I 116 • ©N(- D1, FIRE NUMBE CITY/STATE \Pj1 ZIP 5+0 l b PROPERTY LOCATION: ~G 1/4, ~w 1/4, SECTION, T Z~ N-R t 9 W TOWN OF I1~Y , St. Croix•County, ' SUBDIVISION , LOT NUMBE 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 ears or sooner, if needed by a 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 . h 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 Co. Zoning officer within 30 days of the three year expiration at . SIGNED: Q DATE : 9 l St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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. i Owner of property FL Location of property ~ 1/4 9W 1/4, Section W Township I~ Mailing address *09b 61im la, LI&NIS ~uoso Wt C2 4-0 6ka Address of site y-~ O ice--. D 50 Subdivision name Lot no. A, c Other homes on property? Yes X No Previous owner of property Total size of property Total size of parcel Date parcel was created t - - S Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes X No Volume IVo qb and Page Number 2A51 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 57,5,03+ , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. C22903 <::~at4 5jt',~ - Signature of Applicant Co-Applicant DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 525034 REGISTER'S OFFICE ST. CROIX CO., WI Reed for Record --.Elizabeth._:S>._Murphy,------------------- - JAN 1 0 1995 L at 10:30 A. M conveys and warrants to John•_ F_,-_ Seibel__ and- Tamara- M,------ y~;/U_ 41. , Seibel_,__husband--and.wife,._.as..survivorship..marital....... Regis !j"~eah• (,~J Rter of Derd;, RETURN TO the following described real estate in St. Croix County, State of Wisconsin: Tax Parcel No: Part of the SE 1/4 of NW 1/4 of Section 3, Township 28 North Range 19 West, Town of Troy, St. Croix County, Wisconsin described as follows: Commencing at the N 1/4 corner of said Section 3; thence S27016'W 580.4 feet; thence S1o39'W 1565.91 feet; thence West 625.16 feet to the point of beginning; thence West 397.2 feet; thence North 635.93 feet; thence S760171E on the Sly line of a Town Road 363.1 feet; thence SEly on a 667.0 foot radius curve, concave Sally, chord bearing S74016'E 46.4 feet on said Sly line of Town Road; thence South 537.16 feet to the point of beginning. voo bs ~ FEE This i _ s not homestead property. (is) (is not) Exception to warranties : Subject to easements, reservations and restrictions of record. Dated this daY of January--------------- - 95 (SEAL) - ----(SEAL) * ELIZAB M RPHY ••-•--(SEAL) - --•-..(SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE OF WISCONSIN St. Croix ss. .........••---•••---•-•-""County. authenticated this day of-------- 19 Pursonaliy came befure me this ................day of I ---January , 19._95__ the above named ~ s - - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by 706.06, Wis. Stats.) F~f~!a+,j t)t to me known to be the pe son who executed the A' foregoing i rume t a acknowledge the same. THIS INSTRUMENT WAS DRAFTED BNC)i"AltY I'llffl !y: STEPHEN J. DUNLAP - Hudson, Wisconsin fe*- - St. ix - Notary Public - Cro County, Wis. (Signatures may be authenticated or acknowledged. Both My Co mission is perm ent. (If not state expiation are not necessary.) date: 19 j 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.