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HomeMy WebLinkAbout040-1206-95-000 -0 0 o° 1 G 06 ~ b I O p x C U a I Cl) :y O Y y c CD N 4) Z m LL D m~ Q ° c°n I Cl) Z N E O Z O L Z L a 00 w I a m z o c z ° o z u V r O N m Z v c o F- r z C O E M 0 C m C + cy a. U C O I C c V Z z 0 0 F- Z Q N Z I a ~ I C V E i O y L 10 o C. m w C I V N ` v ~ O > ~ooa 2 O o cn rn (n E O _ ~ L N N F F1-- S: 0 0 0 Z v a a m EL c 7 G N i 'NO 0) 0) rn a) N N U } = N N O O O E M C) 0 N a 0 E v d Q io O C rn O lD N C O E 00 00 O ~ p O N N rn O r- am O r \"i O r - I L' (D O 3 O N C C N N O W C O O (O M \I dj O O w N ~ - M~ B O O 06 0 CN ` ! co m w m co + yr,~' O I-' N O N to O `C V: d m L d V t° £ I L a w 9 CL £ i c C w j `~1 A 0 a 2 0 in L) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS I SUBDIVISION / CSM# C~'~c~yc•- ~S fi4h LOT # ZU SECTION T N-R~ Town of ro ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o S INDICATE NORTH ARRO~~ n1 At 7b Sto/t Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:. Lei&.A✓ Liquid Capacity: ,~Q Q Setback from: Well House Other Pump: Manufacturer - Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches 2 Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: M Q y/ INSPECTOR: 3/93:jt Wisconsi;•,' Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and V0man Relations INSPECTION REPORT ST. CROIX Sa4t~ty and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holdter's ROBERT ❑ City Village ❑ Town of: State PI NANO, X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: U ci. a'r F (i,, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /0 7S 3 / a 5 Dosing Aeration Bldg. Sewer Holding St/Ht inlet 6,0 ?e,771 TANK SETBACK INFORMATION St/ Ht Outlet 618' 9S Vent TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet Air l Septic YiooJ- NA Dt Bottom g_72 q~.o3 Dosing NA Header / Man. Q ;°o - Ra'Os Aeration NA Dist. Pipe 9 mot. 7s ~ Wis. ° , Holdin Bot. System Q'e- 71 U PUMP/ SIPHON INFORMATION Final Grade 7, 5 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Widths Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 30'x!°'So 3 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION SyPem : oZ -71 >50' CHAMBER Model Number: 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 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.l .2 .19W, NE, NW, Lot 20, Omaha Road Plan revision required? es ❑ No WUL/ Use other side for additional information. SBD-6710 (R 05/91) Date Inspect 's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH . ' SANITARY PERMIT NUMBER: _ Safety and Buildings Division 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 County than 8 112 x 11 inches in size. St. Croix 0 See reverse side for instructions for completing this application State Sanitary Permit Nu ber a 8 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Robert Manor NE 1 /4 NW 1/4,-S 16 T 28 , N, R 19 X6W W Property Owner's Mailing Address Lot Number Block Number 615 Hickory Road 20 City, State Zip Code Phone Number Subdivision Name or CSM Number Hiirlqnn. WT 54016 Glover Station II. TYPE F BUILDING: (check one) E] State Owned El City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms bi Vown of Troy Omaha Road III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 040-1206-95 1 ❑ Apartment/ Condo 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 online B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 go Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 562.5 600 0.75 NA 95.0 Feet 97.7+ Feet VII. TANK Ca i Total # Of Prefab. Site Fiber- Exper. n gallons INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank 1000 1000 1 Wieser ❑X} ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber '60eo 4@9' ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se a sy s wn on the attached plans. Plumber's Name: (Pant) Plumber' Signature: (N Sta ) TP/MPRSWNo.: Business Phone Number: Tom Fisher 17N- MPRS 3410 715-285-5671 Plumber's Address (Street, City, State, Zip Code): Star Route, Box 221, Durand, WI 54736 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanita{y Permit Fee (Includes Groundwater Date Issue Issu ng Agent Signature (No Stamps) i/ Approved ❑OvvnerGivenlnitial Surcharge fee) ✓/Y///, \ Adverse Determination #4~ V11 a~_ Z2 1 X. ONDITIONS OF APPROVAL/ REASON FOR DISAPPROVAL: 44.) S81)-6398 (R. 05/94) 661STRIBUTION: Original to County, One py To: Safety & Buildings Di-,ion, Owne , Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. Tana: information. Fill in the capacity of every new/or existing tank, list the total gallons num )-r of tanks and manufacturer's name, indicate prefab or site,constructed and tank material. Ccr--,plete four all septic, pump/siphon and holding tanks ior this system. Check experimental approval only if tanks receive!: experimental product approval from DILHR_ VIII. Responsibility statement. Installing plumber is to fill in lame, license-number wit h 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. Comole_e ;Mans and st-_.:ificatior:s not smaller than & 1/2x 1 ? inches, must be sJ k,- i"ed I ~'he cui?ty- The plans must foilpWlri(.). H) pi©t pian, drawn to SCa{E' Of VIIih COmpiEl Jlt_ ing tank(s), septic u i`'_ ~r_"lt !_ank`~,, building sewers, vvelis, N_ter lakes, oump or siphon r)so l orpt:on systems; repiacerneto: system irF_., i the b±,ilding served; O~;Lc t. +PC _ 'I t'Vc -''D i"=rr E' PC, f c C-ple..e sr F'C cs ;I i.' t0' _;.~'1 tIoIS; d~Se vrJ Urlle; e. r t C(Ce 'CtiCn ~G r; P- rrp performance Cur\.e; PUMP MOdei ori,4 l.'Inlr ,lU'Erf <J cross section o Soli absorption ;ysl,eili II Ulied by ~l:a coUlTiy; test data Gri d 1 j Jr rn, a''r } li ~iZing Information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges Cees) for a number of re( ,,:fated [.racti,:e,: which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater (ontairinatic n investigations and establishment of standards. Page PLAN of . ~Y- Czr-1 P" ti A (zu r, a Sou`t~ ~R►J ~lPt C ~Lp, 6h~i ~ Zoe ~ 8 io'1o 'rL CIS-0. 7 t=rL 0.) y i n.6 ,r--r- L w ~'n i u.Z l vl 1 o 1~ l ' t'1 l01 y i1 ~1 - LrL. 1au,0' o aoJCZ Lem -\,ztct oF, E3►~t~Z - 1. ' S"L) CeL . 100 SO+J R4un.A) IN ICJ"0~h 1-12Cb. t~oust `M- 3E' r'rT LLm-IxZS' V-79:4)-1 owU~l~S : C.wy, Q i ~t 0 ~j I s gcl~uL'r~ rvo , oL40. 12u6. 9s 171 5 ~I Z S o l S M of Y~'Jf?C~nf' r~1o. C51 ' PLOT PLAN Page of M - - S, scAl~ 1q = 30 _ v'-a R H A h fl _ _ Zscl .6 sc%P t R►.) IPtC Rb Look I B 8 lu~1o d, ~"a~oYT'~ w1 oF- t3 W CoA i`tov~2 al 6 t:'L q14 ILA. ~-q6 r-- L d - i'L °11 y t~• 5 - kr-q 8 = o 0 L~ tZ. a o t ® h'1 - LrL 10010* OINJ C(yV ezt-m 1~K`J 0~ Ls NZ.YIZI . k31~ 1♦ Z - . 1 D 1, 0 S' O►J . S 1~ a 1 2' PrC30 UE G 20 U1W 1 N I y " o, h • ~i2 \Ao\aSk el-:- Ofi Lt,-r"-r 2S' V--;Z4M SIIS1~+ V_rU So' cwt S : C , ah. ~y~ beJ~J I S S c11 ULYI iV0 . GqO, IZ-u6, qs z cl aaa~re -7) S) LIZ s_ o 6 s M oo S'76 .k.., Te. hOne NO. CST #f , - K I ~ Z~ N i 4'► (sev ave. 1IL - / i Mr r► I ~~w. E ~~•-b•~ t.~~ 4 Z. r.t*ev~ e. { Ioo.O , 7,0 , 9r.o s.S'--~ F--- j I I C ! ~ I I I - 1 1 I : i I I i I • i ;i I ~ . - - - ' - - _ _ . _ -alp : S - - _ - - - - - ; ~ I - I - - ; , f r I' f i f I I I~ ' ~ ~ 1 I ~ 1 i! ~ r M ~ N I I I I~ f II ,I I I I i ~ 1 I Colt ! I 1 i I I I t I I l i ' I I I I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 'Labor and Human Relations tisision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY ° S~'. Cam(} Attach complete site plan on paper not less than 81/2 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. u - ZO 6 - °1 S APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION C M• 8.4 E - D E1..1A1Is SCttU LTZ OeV+-LOT tv I 1/4 Q LU 1/4,S 16 T Z a N,R 19 E (or MI PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # -ILO N-l. P'►P1lty ST. zo - GLOu S1'trPON CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD R, UTL``"BLS W~ Syozz (-)fs)4ZS_ g16 T2o x371%) A Rz fiD K New Construction Use (SCJ Residential / Number of bedrooms y ( J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow bQ'd gpd Recommended design loading rate o-_) bed, gpd/ft2 0 • b trench, gpd/ft2 Absorption area required 8S8 bed, ft2 SO trench, ft2 Maximum design loading rate 0--) bed, gpd/ft2 0- 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 5.0 It (as referred to site plan benchmark) Additional design / site considerations S tM >u UT oIV P f't 6 E? 3 o r 9 - Parent material SId"4th1M ekj1' oU LI~Z Styv~> C (S" utrt Flood plain elevation, if applicable • It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE 7AT-GRADE SYSTEM IN FlLL HOLDING TANK U=Unsuitable for system Ej S ❑ U us ❑ U ®S ❑ U ❑ U gas ❑ U ❑ S 0 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 Trertdl ~ o-i2 to~.~ z./ i ~ Si l Z`~Sbk m'~~ GS o•S ~-b 4yv Z Iz_zy 10`!IZ L _ 5 ZwtS~ mU~4- cS - u.S o•L Ground 3 Zy-S2 1_)-S111k_ Sly - S Sg ),.I O- S - o• -7 0.6 elev. ft. y si-~ 7 10`1 I- e-, S Q~ S I h1) _ o Depth to limiting oaa factor., '7 7 Remarks: Boring # 01 Z Z 21- 3y b ti li 3 /L S 2 `Fs \bk K7 'f t. c s ` o. s o• L 3 3~l- yS~ S `7 2 3 t y S ~ ~ c S ~Jk Yn v `I" C S - o• 4~ u.$ Ground elev. 8~-S yR S~/6 - S O S t,.t 1 p U. S 9" ft. Depth to limiting factor + 78 Remarks: CST Name:-Please Print Arthur L. W e e r e r Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: G3-X96 3-Z3-y~ M00576 . J PROPERTY OWNER -W'1';E - Sc LTZ SOIL DESCRIPTION REPORT Page?- n PARCEL I.D.# 040 - \106 - 9 S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w`~.'M 3 I o -2-8 do K 2 Z! z s 1 Z S b k a - o, s o• 6 l:•s :r Z Z8-~3 tiv`2R 3~6 3 Sbk 'M f1- - o•S u. Ground elev. q0.o ft. Depth to limiting factor ~-7--sN Remarks: Boring # o-\Z 10m2 it Z s t 1 Z s dk w~`F~. ~S - o• S o y Z 1Z-33 ~•S`i2 31 - S ~ 1 tin Sblz yn U`f _ o. Y n • S 3 a3_►~1 >=s Y2 S o Sg ~ - 0.1 0. ~ Ground v/6 elev. lo\. ft. Depth to limiting ' factor Remarks: r Boring # z,'kq<: 1 o-►u ~U~221Z si•( Z`FSbk wx-c~. CS - o S o•d C4v C•S S~ ) cs~k vv U'j 21-~lJ 7-S `iR 3/ - o s 9 `M ~ c.5 0.~ o.~ Ground _ ~ellevv.. q1_L3 S S yp- VA - S O sg ft ( o . ~ o • 8 . wt Depth to limiting factor i Remarks: Boring # ti ° _LZ \O`11Z z )1 S Z'E3bk \m'F1~ V Z VL-yo ~O`- Z. 31b S~ 1 csb)Z vnv`fH C~-S o•~! `o•S yO -IS ~.S yR Y/6 - S O Tg vh o.8 Ground 'A N ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PROPERTYOWNER11`0~ - SC-iNLTZ SOIL DESCRIPTION REPORT Page 3 ofd . • PARCEI,I.D. # o q o - l Zu - q5 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Tench 6 X 1 o-\3 \o,IR Z !Z - St 1 Z~ Sd `F►. cw o S U. \3-19 t(Yy2 31y - S~ Z~ s~>r v"~>^ c S o.s u.b Ground 3 t9-36 1oy2 3/L _ St I Z~ sbh w,C-- S o.S o• t elev. a ft. 36-~8 7•S yR 3/y - s s w► ( cS Depth to S y$- 1 4 7 2 ylY S O S wf I 7 8 limiting factor Remarks: Boring # s ~lrc Vr 1 0-~Z 6q `12 31Z S 1 0- S w► 'T1. 0-3 b-~ 0•S 8 Z ~Z-zg %,IvZ 3/t Ground 3 4-~~o -)-s v 2 YA - S O sg M1 6 elev. Wo ~-I ft. Depth to limiting factor ?llp~~ Remarks: Boring # lV t5 YQ G UN Q- L \l i-zj J l~ U ►"l Ground L Q U U L e L LL elev. U L~~ S V1~ UZ U ft. Depth to p t o t i cs limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) - PLOT PLAN Page of scaL~ .30' z-vq R t P% _ Z,so ~ Zv ~Sov`citrJ qtr-lRc RD R`►'1 ( Z ZO ~ EL000~ 100)o Tam* 7- EsZ CIS.o' j'Z COt.,`cOV\Z , W$•o I~e.o^i`ro►"1 of Bt's 46~ 9l y n2 L-469 14% B.S 13.3 I ~ Y I trL IoI y i i 'TIM 00 0' O&C-(yu Cat- 1~hC1~ 0~ 1~.~Ttl"C~lC V k , - a►~ tZ - ez. 101.05' OAJ SPI k~ Z-' ftBk e- GR0U&A7 ,n~ ly"~~H l'i2~• r ov5~ - 3E OrT LL---sr ZS' loM syST i°r~='i1S, t ~t IN .t t $'p" at ovvU ZLs : C ,167, eV E( t,k 1hJ Q 1 S S c4 uuTZ XB-Zg(o CZt,O 3_, 23-c~ -71 S ) L4Z s- o! 6S MooS'76 CST Signature ° Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ) of Labor and Human Relations pivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ` - S~'. Gt?(ti tu( Attach complete site plan on paper not less than 81/2 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. (3 1-10- lZp 6- 9 S APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION C, Y-11 N34 E - D RAJ Is 0a'0_t1'ULT7Z GEIVF-L: T t-) t; 1/4 1J W 1/4,S 16 T -6 N,R f cl E (ore PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBO. NAME OR CSM If `1 l0 ►~P+tti ST• Zo - ~~o~L~ S1'ttfiUN CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [-]VILLAGE MOWN NEAREST ROAD 'R. U LM 7'-ims Lv s v r, z z I S) 4 ZS _ g 16 - 2,0 (3 1,17-', " Rau f4 D K New Construction Use [S(J Residential / Number of bedrooms `t► [ J AddiiiQn to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow boo gpd Recommended design loading rate o bed, gpolft2 0.6 trench, gpolft2 Absorption area required 8SB bed, ft2 SO trench, ft2 Matamum design loading rate 0--) bed, gpd/ft2 0- 8 trench, gpdfit? Recommended infiltration surface elevation(s) 95.0 It (as referred to site plan benchmark) Additional design / site considerations 5,t• IOOTZ otv pb t&l 3 ot= `l - Parent material S e1th%" 9uT• ou k* St Kjtp f G Rif vct Rood plain elevation, if applicable N It S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system 1~ S ❑ U WS ❑ U IRIS ❑ U ®S ❑ U 14S ❑ U ❑ S IT11 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 rt~1d1 o-t2 ~o~tZ z~ Z si l Z~5b)z r, GS - o•S o•6 Y.•. vvtr Z I2-2y l0`dR 31L - S ZwtS~k VNwf cS - n,S o•1 Ground 3 Zy-5Z -).SyIZ 3/y - S Z) S5 h~ cS - 0•-7 o•$ elev. a!.~ft. 4 SZ_1~ I o ti IZ ~rl - S S9I J - o-`~ a. Depth to limiting factor ' 7 77 ~ Remarks: Boring # Eff Z Z-)-Sy ~oyti 3/6 _ s~ 1 2`fs~k ►~'Ft cs a.S o.L Z < k0 3 Y/_Vy D•S'tR 3 ly Ground elev. yV-8 V y2 YA - S o 35 wi 1 - o U.8 96• eft. Depth to limiting factor 78 ; Remarks: CST Name:-Please Print Arthur L. We erer Phone- 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Q_ Cl 3_ Z 96 Date: 3- Z3 y ~T Number: M00576 PROPERTY OWNER SCt{UL?Z SOIL DESCRIPTION REPORT Page• Z o~ PARCEL I.D. f! 04 0 - \10 b - °I S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundwy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench RNMIUM, 3 ~~y o _z-t3 > o Z/ Z s 1 Z s bk t^ - o, s o• 6 30 Zf 57 ~M 'G Ground elev. 00-o ft. Depth to limiting factor 7'73" Remarks: Boring # . € 1 o_\i vwitLzJZ O.S;o Fa y Z 1Z-33 ~•S~ifZ 3J S 1 M Sbh yn v`f h cS _ y o. S 3 a3-)t31 >=S 7Q V/6 S O Sg - o •"1 o • $ Ground elev. 10~_ ft. Depth to i limiting I factor Remarks: Boring # cs 1b-ZI S~>: Z 1, 0 y R 3~ L s) ~ c. s~ ti irn v~ C ~v - o, 4 o• S 14L>~:•:t:i::ii:fi ZI-S 11 P- 3/ - \ S s 9 ~S b.1 0.~ Ground - elev, y/_RS -)•S ya. V14 - S 8 osg 0.1 u• --1 ft. Depth to E limiting factor , Remarks: Boring # I o - LZ ~o \Z 1 Z s i 1 3 ~1•t Vvi `rr ~ c S - o . S j o . ~ Z 12you \'o~tl~. 31L S 1 C- sb1Z VVI\j o•y lo•S ram Y/6 - S O sg w► ` - ~•7 jo,~ yp -IS 17- Ground el g ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PhOPERTYOWNER~`-t~ - SCNUVZ SOIL DESCRIPTION REPORT Page 3 of~ PARCEL I.D. # o y o- l ZU 6- q5 Depth Dominant Color Mottles Texture Structure Consistence Bcunclary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer 6 0-~3 X0"12 Z IZ Si I Z~ Sd mt- LA-.) - o•_S U. \3 -19 10 31 - S Z vn Z c, S o• Ground 3 19-36 loyR 3/4 - S11 Sbh 'M`f►- cS elev. 0 1 :0 a ft. 36-y8 7•S yR - S s ( cS Depth to S yq- ) b 7 R Lay S o S I b o- 8 limiting factor 7 rdo Remarks: Boring # OS I o ~Z tib y Q 31 Z ~ s ~ l c g $ Z n-2$ %-t2 3A S O S9 wt CS _ 0.7 U• ~ Ground 3 4-11o -).S fa YA - S o sg wf elev. wti - -1 ft. Depth to fidti%Ctor >tIQ' Remarks: Boring # , o J FILL- L L Ground b Ci 06 elev. ft t--) lam- \ U L~~ S uv:- M- U Depth to p t p1 rV G limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBO-8330(8.05/92) PLOT PLAN Page -V of -L s cR ~ . 30 ' a ZSO ~ swj'r ~k~l i CIRC RD, ~`''1# I ZZO EFL, L00 $ $ lu'~o `a•0 I GI I3.lo " -46~ ~,Vp 4gBuZ • fit.. ~s9S•o' B-5 EL..98'_ rJ IS, Q• 3 e•y tom- l~1 4 D ~ I 13U 1C , 00 .0' cmj C(YU c4tm ~1 `U OIr !_~-~l'IZ !0- O►j SPI" Z•' S OUE GROUP iN ~U"~~N `flZ~ t~nvS~ 3E ~'tT ~~srtsT zS' P"m SySTe i°r 1S. ~L 4 4 ` • So, tt a t owU C1ZS : C , v-~, 3y~ C~ O1"J I S S cl~ ULYI ot4 o. ttu6. 9S 1S ) ~-1 z s_. 016 s M Oo 57 6 CST Signature 7 Date Signed Te ephone No, CST # 4 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/BUYER MAILING ADDRESS 'C ZT' PUZ er PROPERTY ADDRESS I S?•t k ~r `~E' (location of septic sm) Please obtain from the Planning Dept. CITY/STATE) Uv~c ll~ W PROPERTY LOCATION 1/4, 1/4, Section T N-R_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ~1 b y ~G- ~Gt ~l D ^j LOT NUMER 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. UWe, 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. SIGNCD: X~~,, ~2~ 3_ - - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 1 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Pit, A y.-~- /V74 AA j Location of property 1/4 1/4, Section 0 ,T N-R _W Township fl.) u Mailing address ~d u,,,fX.~. P von s a•v2 ~f P>I fi ifp~ Address of site Subdivision name Cr ~n y ,e S 744 ca v Lot no. other homes on property? Yes_X No Previous owner of property ,VI Sc/iI_j -14 e.W _S Total size of property p / c~-,e Total size of parcel a?= j ~cA S Date parcel was created Are all corners and lot lines identifiable? Yes No Is this pro~erty being developed for (spec house)? Yes No Volume 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 in the office of the County Register of Deeds as Document No. , 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. /6!yC ~-~1 Signature of Applicant Co-Applicant y 0?- 3-- FS- Date of Signature Date of Signature + ♦ , THIS aFACL RE9aRV[D FOR RLCORDINO DATA DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1988 Wq AMTY DEED 52'760'7 Vol k 7va,-F2'9 " RFGISMS OFFICE St CROIX CO., Wt MNIS R. saMTZ and need for Record This Deed, made between g•:..t . , . ea ch APR 1 0 1995 .-.k1..$, . ..in• tie r- own,. rih Grantor. at 11:15 A • M a>na----..BUBEnI'..I....~1P.1K01?.aDld.~'1ARII.YkI..Cis..k~1~K2R,.._aS ~aff~Q+a.,,,c~. (,e~aAa4+. marital..surxixQxship..pxQpexty, R ter of Deeds ' Grantee, O WitneSSeth, That the said Grantor, for a valuable consideration...... !D - A-L RSTURN To conveys to Grantee the following described real estate in .......,fit..-CI'0 PO BOX 167 ver Falls, WI County, State of Wisconsin: Tax Parcel No: ~ - X 206 q5 -71 1'> F~ SC-V Lot #20, Glover Station, Town of Troy, St. Croix County, Wisconsin. is not homestead property. This (is)°•---•---(is - not) Together with aB and singular the hereditaments and appurtenances thereunto belonging; And_._........lOll_S - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I mmicipal and zoning ordinances, easement for public utilities, and building restrictions of record, and will warrant and defend the same. 1994_.... Dated this ...........Zxnd day of WfMbgr........._...... . ........................................................•---........(SEAL) • ennis R.--Schultz... -----(SEAL) (SEAL) ' C-M-Byre---------------------------------------- AUTHNNTICATIO!Y ACBNOWLNDGMBNT STATE OF WISCONSIN Signature(s) es. St___CxS1iX------------------- County. y~ authenticated this day of 38 personly came before me th .day of (emu ,r,° the above named 19 I?eBnig.chultz anc C..M:..BYe ' - TITLE: MEMBER STATE BAR OF WISCONSIN not, (Ii - anthorued by 708.06. State.) to me knows :o be the person who executed the foregoing instruA ntSafi 4&4owjjedge the same. THIS INSTRUMENT WAS DRAFTED BY _ , f•F M.....--------------'----..........---•--------'-'---. t T T Attarney. ) My Comm !lot, state ezpiraticn PubBcd - County, Wis. is (Signatures may be authenticated or acknowledged. Both r 19.97-_•) are not necessary.) date: eN.,S or persons signing in any espacitr should be typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Lnal Blank Co. Ina WARRANTY DEED FORM Ns. 1-1932 Milwaukee. Wis. e jas.'sWw Vt+*$?-'V4:-`"TP.'.' 'ft' M ST. CROIX COUNTY WISCONSIN ti ZONING OFFICE I M N u ■~r~6 ST. CROIX COUNTY GOVERNMENT CENTER ,,N. , 1101 Carmichael Road Hudson, WI 54016-7710 _ (715) 386-4680 March 18, 1996 Robert Manor 549 Omaha Road Hudson, WI 54016 Dear Mr. Manor: On September 6, 1995, a code complying sanitary septic system was installed on your property located at Lot 20, Glover Station, NEB, of the NW;, Section 16, T29N-R19W, Town of Troy, St. Croix County, Wisconsin. The system was installed by Tom Fisher, Master Plumber Restricted Sewer License No. 3410, and inspected by this office. It is sized for a three bedroom house. Should you have further questions, please contact this office. Sincerely, Mary . Jenkins Assistant Zoning Administrator Plumbing Inspector License No. 4626