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Home My WebLink About016-1045-30-000 Wisconsin Department of Industry, La SOIL AND SITE EVALUATION REPORT Page of -3 bo,jand Human Relations Division of Safety b Buildirgs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST C~~l~ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. J f. dimensioned, north arrow, and location and distance to nearest road. Soi/s APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~„e~~~>Ea Z3 REVIEWED BY DATE pso.J PROPERTY OWNER: (WE(r PROPERTY LOCATION /////S Nti - /3 3 GOVT. LOT 1/4 5Sw 1/4,SIV T • 36 N,R /S E( 'r'J PROPERTY OWNERS MAILING ADDRESS VTI LOT # BLOCK # SUED. NAME OR CSM # 2 3 G CTy, ~w G . ~ l3t.PT a,= if c,P~s CITY, STATE ZIP CODE PHONE MBER OCITY []VILLAGE g TOWN NEAREST ROAD G/E, 4,00D G/ /Y /v/, 5-V013 (715) zC,s- 762-5 G/~.~c~oov ,Icuy. [ j New Construction Use [rf Residential /;umber of bedrooms 3 Addition to existing buikiing GCj Replacement 3 IV6 w - 0 L = 4 ,Y61-11 Code derived daily flow 940 gpd Recommended design loading rate _ S bed, gpdA12 trench, ~v gpdfit2 Absorption area required 7-50 bed, ft2 750 trench, h2 Maximum design loading rate S bed, gpdrft2 ' G trench, gpd/it2 Recommended infiltration surface elevation(s) SEE • 3 It (as referred to site plan benchmark) Additional design / site co ations 5'TE SU'711~.6 /E Oa y Fo,C -410 u,up Pareot material /'~9,6~ey 51 ,E. 10.9 "OR Flood plain elevation, if applicable It -7 rU= table for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM FILL HOLDING TANK suita ble for system OS U WS ❑ U ❑ S U ❑ S U 1:1 S U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerx~t v- 9 io R 3 y /a~,y 2 .f, s 6& .1v= Ae a s 2--f s G E 9-/ '47- /o ye 113 Z f; sb f re es 2-f- . s G Group 8, Spy /oyR 513 elev. fL C - 3 G 7,5 yK Lyp- 5/0 , 2 . S/ 2 h f 2 cS s=~ Depth to limiting faces. IGINA L t Remarks: _~GT%UE /fGw Sit, ~T 3 y " Boring # ~2 T f, 41-f,P nS f . S - (o 16 M 3 /opt-y k s c -15 /Uyl 613 z,~,,Sbl~f,e 4" 2, - 26 Ground If / S/ S 'R P/~ ~G/ Z , , h k 2 S y . S 4.4 P elev. 1 Z 26-31 7,$ //2 51 ? C'/ 5 =%/2 5 / ~ 2, b k' i2 C s 5 ft. C 32- ybYX ~-13 C/ <?f, /W V E Depth to i N In N P limiting factor " Remarks: /Ah/G'W SfEE PA -E" AT' 3 p CST Name.--Please Print Lt3 R CC k-r ~ Phone: -715- 3 ,~(y -,P/Ps Address: (O s s O` ti el L ~ O H U D So j W I. Syoi G 60- )--3-13 CS 7°Af -2yT2- Sgnature: Date: CSTNumtkx: v1 S`%fSoy?// 7-"7-ViP~tFv 4T 1.5- ii T~7P,%'f ~iP .PEp/.~«~rE.c7T /Ll0!>.vv sJ/STc~`~-I 2- a- /t/ 'Pr» T of zoo, ff Z IA.,' 13 4 ClC -7 141T ~G.4r y. zvs~~f/tea? .vusT- 61WEfur// C6' s6 L Plow ~I ~Zof 3 ' PROPERTY OWNER Z-1, ' 1301 SOIL DESC, _.JION REPORT Page PARCEL I.D. ff Boring # Horizon Depth Dominant Color Motties Texture Structure Consistence Bourclary Roots GP~jrtz in. Munsell Qu. Sz. Cont Color Gr. Sz.`6h. Bed Trench fD-f /o Y,f X13 /o,f", z, f, s bk nMf/z CS 3-f~- , s 6, 3 E If-y 7,s ye 1111(e' 51 2.^•.n , hk nwf 2 C S z Uf- s C i , S G Ground 131 /y L3 7 5 yko y S~ 1. A., , s, & ~ v F m 05, elev. ft 13 L 13 -36 7, S '//Z 0 2 ` $ / Co S~ z n~ , s 6 n^^ C' C ` S s/ -M, 2. 5c 1 o f.as t"v NP Depth to y(o 7, 5 o !jx s / CP limiting i f?r Remarks: /jCT%U /yew St ~J~~t(r ~t T 3 G Boring# o, S ~p yR 2.f, 510k nM-R S 2~f 5 } . G 2- 15 YX Ground elev. 7. 2 h/C . S IL JL -133 7,5`~ i ` s n~ASSi'v~ Depth to limiting C lJ 3~e /D ~.3 0 3 10, f, ~ln L) -P I' i 6N factor~_ ~ Remarks: S£ p~ T Z Boring # t Ground elev. ft ~ Q Depth to IGO I NZ, facia Remarks: 8 Boring # ' E3 Ground elev. ft Depth to limiting factor Remarks: *on 0911/.10 AC MM A STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSMj_ LOT SECTION .S,-- Ty N-R. W, Town of G'/ e& GriodOl ST. CROIX COUNTY, WISCONSIN / /02 PI+AN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C l li b I: I SAP f-~c' i INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. a vs ~`/aaoo w 9/ BENCHMARK `jO~Se ld~, 7~~ ALTERNATE BM: ' SEPTIC TANK / PUMP CHAMBER / HOLDING-.TANK INFORMATION ' Manufacturer: Liquid Capacity: House Other Setback from: Well - _ Pump: Manufacture Model# Float seperation cycle: Alarm Location SOIL ABSORPTION SYSTEM l :Width: Length Z,)~, Number of trenches f /✓Opf~' Distance Direction to nearest ProP. line: House 1 ~ Other Setback from: well: ELEVATIONS l Building Sewer~ ,7 ST Inlet; 9- ST outlet , PC bottom P ff • PC.~t_ o Header/Manifold _ gptwt6iu of system Existing Gradb_Q . Final g"'rte IVA c 9 V ,,,,q 9 ~ DATE OF INSTALLATION: PLUMBER ON JOB: uv LICENSE NUMBER: 147'o INSPECTOR: -1-~~ 4 -77 v 3/93:jt Wiubnsin 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.: Pg~miYer's D(~S ❑ City ❑ Village] Town of: State Plan D No.: 6-104-5-30-000 CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No A 31 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( Benchmark Do 'n Aeration Bldg. Sewer ng St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic >/4) NA Dt Bottom Dosin NA Header/-Atom 91,/ Aeration A Dist. Pipe H Bot. System ~v FPUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Num GPM TDH Lift Friction Ft I Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM DIMENSIONS BED/TRENCH Widths Length ~ , No- Of Trenches p No. Of Pits Inside Dia. Liquid Depth DIMEN SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI Manufactur SETBACK INFORMATION Type O CHAMBER Mticlel Number: System: tl-en C OR U DISTRIBUTION SYSTEM Header t r Distribution Pipe(s)/ / F!~~ x Hole Spacing Vent To Air Intake Length Dia. Length 70 Dia. `f Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste y Depth Over Depth Over f f. xx Depth Of xx S d / Sodded xx ISCIZI'lTrenchCenter ~ 7 ~PTrenchEdges o~Y ~7 Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD 20.30..15.327A,SE,SW,CO. RD. G `f l'' Cf v ~ r, Plan revision required? ❑ Yes Ca'1T0__ 441M Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No. ADDITIONAL COMMENTS AND SKETCH . SANITARY PERMIT NUMBER: ®ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY aa~ iaas,° a.an.a.aa,w,aM STATE SANITARY -Attach complete plans (to the county copy only) for the system, on paper not less than l/r ~tY PERMIT # 8% x 11 inches in size. Check If revision to p evious 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 14 ° S 10,44 SS ,S5 %4 .SIiJ%4, S 2.O T-FO, N, R /-5-9"T) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3 6 Rd G CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE: NEAREST ROAD 6 e flood (mod W, G 'FAIFIGEL TAX ❑ Public 14 1 or 2 Fam. Dwelling-# of bedrooms 9- NUMIJI 111. BUILDING USE: (If building type is public, check all that apply) s- .3o 1 ❑ Apt/Condo b 20 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 in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ 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) Qp,~,s ELEVATION b i~8i Feet , 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 structed Septic Tank or Holding Tank e S _1~ Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT 1, 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/MI11111111111IN No.: Business Phone Number: 6--,4 L s-/ 9'd Plumber's Address (Street, City, State, Zip Code): 2 Al 1 woo o/ C °7` ~i .5- o/ IX. C UNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue I ing A nt SI ature (No S Approved ❑ Owner Given Initial ~ surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at 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 suo(nitted 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. 111. 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. Vill. 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. S1313-6398 (R.11/88) - I ~ j 14 r, Al , lpA #r- de I~- _ j i ~ T 0 0 0 I- r~~ F I I 1 I I _LJ j -I _ I, I j t a i - i I - ; I %V001M In D1LHR SOIL AND SITE EVAL )N REPOR1 _ In accord with ILHR 133.05, Wis. Adm. Code / 3 COUNTY Attach complete site plan on paper not less than 8 1 /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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION R S SS GOVT. LOT,SF 1/4 SW/ 1/4,S,20 T ~p N,R W PROPERTY OWNER.'S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUM ER []CITY []VILLAGE ®TOWN NEAREST ROAD G eNwaa0l Ll s %~l7.Cr)~ ~ezo e wood R~ G [ I New Construction Use [ I Residential / Number of bedrooms Addition to existing building ()I Replacement Public or commercial describe Code derived daily flow .rO gpd Recommended design loading rate gybed, gpd/ft2 . trench, gpd/112 Absorption area required - bed, ft2 --5-Xg trench 112 Maximum design loading rate a gibed, gpd/112. trench, gpd/112 Recommended infiltration surface elevation(s) L.0,2-5-_ 9 q 11 (as referred to site plan benchmark) Additional design / site considerations Parent material (5z'l A C i i4 ,G "7-I Z Flood plain elevation, if applicable IVA It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system 1 1 S ❑ U ®S ❑ U 29S OU ❑ S O U ❑ S Ef ❑ S MU 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 Trench S a A /r M. Ground I ?a -,01 7,,r 6 S ~ /t G C w ~ 7 . P elev. Depth to limiting factor 7 ii ~ Remarks: Boring # 6 ~4 .41v 3 . ,5' M-21 hl R 319 S~ L.2 56/Y F Ir c F -5 Y) S'q M Ground elev. Fa 14 it. Depth to limiting bc1or > Remarks: T Name:-Please Print G~ e W SM Phone: 0-2 ress: 3 2 a ► 70 ~.L e N fdo v d G'/ ^7`I ~i .5- 0%3 Signature: Date: CST Number: 71. 2 D ~fJ 9 /7Z*' PROPERfYOWNER J;i Ite,5- ,LASS' SOIL DESCRIPTION REPORT PARCEL I.D. # d A~ - /D . p Page 2 of 3 Boring # Fi3 Horizon Depth Dominant Color Mottles Structure GPD/ft In. Munsell Ou. Sz. ConL Color Texture Consistence Bo~xtciary Roots Gr. Sz. Sh. Bed rerxh Ground elev. ft. i Depth to = limiting ' facto i Remarks: Boring # f Ground elev. ft. i Depth to limiting factor i i Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ I Ground j elev. ft. Depth to ` limiting factor Remarks: - a ~ ~Q ~-e . ~ - - ~ i R i - CA- I- i - I C ---~-I 1 _.'__I I i h I i L- Y j- -r _ I I I I 1 r TL_ - I I r I I I ~ - EL- - i I I I~ 1 C!--- I H-A ILA_ -4- : _ C i T- 1 I it - : I : I 1 I i1 I , I I _J r-- r i t L STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER %,7- J°,~A S S MAILING ADDRESS A-1 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, &'A/ 114, Section 02 d , T .~Q N-R_Zs;§7- W TOWN OF ~r LAN w ~ O 4/ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 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 y expiration date SIGNED: DATE: ~,/.S y St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 B T C - 100 This application form is to be completed in full and signed owner(s) of the property being developed. An inadequacies the only result in delays of the perm Y ~luaocies will development be intended for resale it issuance. Should (spec this the house), property then a second form should be retained and completed when is sold and submitted to this office with the appropriate deed recording. r - - - - - - Owner of property /A4 / ' ~f SS Location of propert Y,j1/4 $u_J 1/4, Section ~T7N-R W TownshipleI l."OtJd Mailingaddress C;2 Address of site 0~3 Subdivision name other homes on Lot no. property? Yes----,)( NO Previous owner of property Total size of property M Total size of parcel d ~ C Date parcel was created Are all corners and lot lines identifiable? --X No Is this property being developed for (spec house ?Yes Yes Volume O d and Page Number ) Yes -X-NO of Deeds. as recorded with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. PAGE certified survey, if available, would be helpful so asdtol avid a delays of the reviewing references to a process. If the deed description shall also be re Certified Survey Map, the Certified Survey Ma quired. P PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to t best of my (our) knowledge that I property described in this infor(we) am mation( form the owner(s) of the warranty deed recorded in the office of the County virtue of a Deeds as Document No. own the ~ 7 and that I (we Register of proposed site for the sewage disposal system) orr I (we) obtained an easement, to run the above described ) construction of said system, and the same has been duly reco the office property, for the of the County Register of Deeds as rded in ~ Document No. n ure o Ap licant Co-Applicant /j q C Date f Signat re Date of Signature i I • DOCUMENT NO. I+ r WARRANTY ;DEED THIS S SPACE RESERVED FOR RECORDING DATA TTE BAR OF WISCONSK~1 F",1% M 2 -1982 - II s 18~ 14 ?AGE 359 STER'S 0 Greggry_.H,_-.Lindbom_ and Connie J. Lindbom ~~'CE I~ ST. CROUC CO I __-husband__and_-wfe_~___as__survivorshi marital Co, W, ..--property 1?.... Recd for Record ~I JAN 1 conveys and warrants to - 4 1994 •-James-A.....Piss;,. .-ainale..---•---•-• at lic45 ~ ----pers.Qn•-•---•......---•-.....-.••-••--••------------------••--•---••. M ''''t,.QQ. lReBlscerotDeeds RETURN TO . the following described real estate in S__t___•_ CrO1X State of Wisconsin: County, Tax Parcel No: Southeast Quarter of Southwest Quarter (SEk of SWk) of Sect Twenty (20), Township Thirty (30) North, Range Fifteen (15)ion West EXCEPT East 1 rod thereof. I This i.S_--111LQt....... homestead property. SX(is not) Exception to warranties: Easements and restrictions of record. Dated this day of January 19_.9 --(SEAL) -~L V C4' (SEAL) Gregory • H. L_i_ndbom (SEAL) ~II . - -•-1AC1!J~~►1----(SEAL) Connie J. Lindbom AUT$ENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN St. Croix ss. authenticated this day of_ County. •----._-119 personal) came before me 7th Januazy day of 19 the above named - Gx-eg_or.y_--ii---Lindbnm__and-•C.Qnnip.-- TITLE: MEMBER STATE BAR OF WISCONSIN J-•--.Lind.b.am----------•--------•---------------•------------ (If not authorized by § 706.06, Wis. Stats.) " v10% y\ to me knbwn to be the person S----------- who executed the THIS INSTRUMENT WAS DRAFTED BY f~ U trument n acknowledge t e. omas A ~ Th McCormack Baldwin, WI 54002 ` sDf2S F County, Wis. are not necessary.) (Signatures may be authenticated or acknowledged. h04,V !M•s' 0mmisslon 'is per 'G-------------------- manent. (If ~ not, stastate expiration lr per .,date: #4ftry-f'ublie•Slate of l+V Iseonsin---, 19. - _ My Commission Expires Mar 6. 1994 *Names of persona signing in any capacity should be typed or - printed below their signatures. s. WARRANTT DEED STATE BAR OF WISCONSIN rnvx: _ Wisconsin Legal Blank Co., Inc. Wisconsir, nepartment of industry, Labors umanRelations PRIVATE SEWAGE SYSTEM County: uildingsDivision INSPECTION REPORT ST. CROIX GENERAL INFORMATION ATTACH TO PERMIT) Sanitary Permit No Permit Holder's Name: PLASS, JIM ❑ City ❑ Village i Town of: State P CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Holding Bldg. Sewer St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. FAi entto ROAD Dt Inlet rIntake Septic NA Dt Bottom Dosing NA Header/Man. F Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade gNumber r Demand GPM Friction stem TDH Ft ForLength Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches DIMEN I N PIT No. Of Pits Inside Dia. Liquid Depth DIMEN t N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER System: Mo a Num er: OR UNIT DISTRIBUTION SYSTEM Header/Manifold RARE nPipe(s) Length Dia. x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only [Bed h Over Depth Over Trench Center xx Depth Of xx Seeded / Sodd No ed xx Mulched Bed/Trench Edges Topsoil ❑ Yes ❑ ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Glenwood.20.30.15W, SE, SW, Highway G Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY -Attach complete plans (to the county copy only) for the system, on paper not less than /w e o 8% x 11 inches in size. STATESANITARY E MIT# -See reverse side for instructions for completing this application. ❑ Check if revision to previous application 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. STATE PLAN I.D. NUMBER PROPERTY OWNER a G ~6 # 6-S PROPERTY LOCATION PROPERTY OWNER'S MAILING ADDRESS LO -S~ S D T .~0, N, R ~r) W 11 v G LOT# _ BLOCK# CITY, STATE ZIP CODE PHONE NUMBER .f: e# 4et,p SUBDIVISION NAME OR CSM NUMBER If. TYPE OF BUILDING: (Check one ❑ State Owned ❑ VILLAGE NEAREST ROAD ❑ Public Emil 1 or 2 Fam. Dwelling-# of bedrooms as 4iOB~ fix- E X NUM ER( ) III. BUILDING USE: (If building type is public, check all that apply) 1 El Apt/Condo & /Z- Ar 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 3 ❑ Campground 7 [1 Merchandise: Sales/Re airs 10 ❑ Outdoor Recreational Facility 4 ❑ Church/School p 11 ❑ RestauranUl3ar/Dining 5 ❑ Hotel/Motel 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 9 ❑ Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) 13 ❑ Other: Specify rVI A) 1. El New 2. ® Replacement 3. ❑ Replacement of 4. ❑ System System Tank Onl Reconnection of 5. ED Repair of an B) El A Sanitary Permit was previously issued. Permit Only Existing System Existing System V. TYPE OF SYSTEM: (Check only one) Date Issued Non-Pressurized Distribution Pressurized Distribution Experimental 11 El Seepage Bed Other 12 ❑ Seepage Trench 21 E1 Mound 30 El SpecityT e 22 El In-Ground yp 41 ❑ Holding Tank 13 ❑ Seepage Pit 42 ❑ Pit Privy 14 ❑ System e Fill Pressure 43 11 Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft. • SYSTEM ELEV. 7. FINAL GRADE / ) (Min./inch) j /a_ F ~ ~ ELEVATION VII. TANK CAPACITY rJ~ Feet Feet INFORMATION in allons Total # of Site New istin Gallons Tanks Manufacturer's Name Prefab. Fiber-Con- Tanks Tanks Concrete st ucted Steel glass plastic Ap Se tic Tank or Holdin Tank d pp. Lift Pum Tank/Si hon Chamber N F1 F1 F-1 F Vlll. RESPONSIBILITY STATEMENT e 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) e ~ Mo•' Business Phone Number: 6~Plumber's Address (Street, City, State, Zip Code). ~tJ 9v 71,r IX. COUNTYv/DEPARTME USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Approved ❑ Owner Given Initial Surcharge Fee) a e ssue Issuing A nt Si ature (N to A ve D termin I n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. expiration 2. Your sanitary permit may be renewed before Code he be applicable. and at the time of renewal any new criteria in the Wisconsin Administrative 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 must be pumped by a licensed submtitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) 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, 6013-266-3815• To be complete and accurate this sanitary permit application must include: 1. Pro erty owner's name. and mailing address. Provide the legal description and parcel tax number(s) of p where the system is to be installed. PPIi 1 or 2 Family Dwelling. ll. Type of building being served. Check only one and complete boxes# of III. Building use. If building type is Public, check a appropriate 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 exist n9 to#k, list the total gallons, number of tank al app material. Complete for al VII. Tank information. Fill in the capacity every new royal only if tanks received refab or site constructed and tanks and manufacturer's name. Indica fopthis system Check experiment septic, pump/siphon and holding tanks experimental product approval from DILHR. appropriate prefix (e.g. VIII. Responsibility statement. Installing plumber Plumber must sign application form number with MP, etc.), address and phone 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 lot Ian, drawn to scale or with complete dimensions, location of plans must include the following: A) p p ns/water service; holding tank(s), septic tank(s) other treatment tanks; building sewers; d stribut on boxes; soil absorption) sys elms; rep a cement system streams and lakes; pump or siphon tanks; eleva ints; areas; and the location of the building served; B) s and cont ols; dose vollume elevation d fferrencefsrfrictionoloss; pump pcompleteerformance curve; pump specifications for model pump and pump mangfacturer; D) cross section of the soil absorption system if p 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. SBD4kM (R.11/88) ` . a r SAFETY & BUILDINGS DIVISION t- k" k State of Wisconsin Department of Industry, Labor and Human Relations April 21, 1994 201 East Washington Avenue P a Box 7969 of Madison Wi 537()7 r ULBRICHT & ASSOCIA1 -may ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 9 RE. PLAN 594--00865 FEE Rf CE IVFD- 190.00 PLASS, JIM Sk,SW,20,30,15W TOWN OF GLE.NWOOD COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewod the above--referenced subruitt.al i Conditional approval is hereby granted for the system plan submittal. All noted items must be correc.tpd. The review anti approval of the system is based on chapter 145, Wisconsin Statutes, and chapters it.HR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters IL.HR 50--64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or j if a sanitary permit is obtained, plan approval will expire (in the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's, stamp of approval at -the construction site. The installer shall notify the appropriate inspector when inspection,, can he rnado. Al] permits required y the city, village, township or county shall be obtained prior to installation. Inquiries should be dirprt.ed to me at the number li-ted below. Please refer to the plan number shown alcove. Si erely, //lames Quinlan Plan Reviewer Section of Private Sewayc: (609) 266-3937 SBD-6423 (R. 61/91) - x ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers Engineering Systems Private Sewage Consultants 715-386-8185 PROJECT INDEX DILHR Plan I.D. # Syy- a o Date y' yy Owner T i m Pt,,*5 s Phone 7~~j 2 5~' yG Z Address 2 936 lfwy. 6- GIejLo ooD 5y of 3 Legal Description SE, Sw, Sic, Zo T 30 Z, R ►5 Z-v PAeT of 4-o Acizs - Town of A3 LO n o 0 County ST-. C P. o r K l 1 C.S.T. ~0t3EIIzT- 2(IbRichT" CSTrf Lgooz Installer _ Local Authority/ Superv i si on ST C Ro i X C oUA.3T-y zoa t- a G- b6 P Tr- PROJECT DESCRIPTION RE ~IAC EK&A j M o U.-.) D 5 y S TI M - O PL E-K(S TTi-Z-6-- ~2 ~ED12M 'Fl'ees 1~ t~4Z LoN A how 1-►0 0v Sys U leU & .41 Slope- C6 Q 4-p U rt. ; wilt k .S► • z c D FO k Jct i' i v OF 950 &A15- WA-5-147Fiow -~,~y • MaVA-)D t0:tt I~a eD :op, $oi~5 A1)i,O Cr PATE of G-Pfl ~'F'~•2, 20" of SAND tl / sED. I- e7 A4 /A t- I/ U /,E7 Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS 40 Pg .3 PIPE LATERAL LAYOUT Jim; Pg.4 DOSING CHAMBER CROSS SECTION W. Uu9jCHT . 61160 Pg.5 PUMP PERFORMANCE SPECS I& j Huoso~ i, 'ts ~S I Q11~~1~~ ~11lIM~s S94-008,65 ' NoT~ Exi Sr»~ WE(~ (iE5 SSA wESr of tio M w~u Nor showN • 21 6-XCSrlN G- TAaks (SEprrc 3 1,~2ywe ll) will f3L-- i4t3A006 .-Ie0 ZLN R °1p TAfJKS ARE' of UNIcNOw.a 5i2E 3 CaoPe-riajS. • ~RRiafiLL.D IN Noy- C4.•t~liA).Ir Soi(S will ~ISc~ . ,tr /3~4GKtioE r~•T-s 0 r3 0 2 o02. 1 y (3 i / 2 . y O nR wF// f3 3 /oo. ~g +1 NEiu /oao ~ . i°.PECAsr S~pTi'c T o Mouup SysrEM ElEVgrloA..~ r ~y O, io9o w/ ao" SAND = loy. 52-' A Q fij hF "S r F, Q ExrSTwCr k "'s; T. OF INDUSTRY, LABOR & HUMAN RELATIONS W e ~ DIVISION OF SAFE AND EUILD1 S J R FTe 12 F (Re f~ •-r~2 C~ v Q v IgYZ SEE CORRESPONDENCE V ~ s 3V ~ "lap r d~ a J~' O quo Pew too :m -m -MM PREChST ,gyp ~L~ \ c~0 as Pump "AmU p a. o BZ e rap o~ 31y 3y _ yp T9 V:s 1r ~ ~ ra a o Ion. i 00 c a~ °s o 10 = h h h ~ SoiL- S L~ 9N coRNeR aF w s~)4 -o o 8 6 4a ACIeES5 let Vr Y 3 u~ W4TrR IN p i w CL INVtR 7- o/-- IdTc-P4/S 1-E U,-T.I'on) S r0 p OF R O C K /o S. 2. 9 S f, Page Z Of TO p O l i A T-ff F1 L- 5 /0 5~. l Z. Synthetic Covering Distribution Pipe Medium Sand _ FI - G s y STEM Topsoil E16VA7700 F IoySZ 3 E D u % Slope uN R Fat e7 Bed Of 2r'40 li" Force Main Plowed Aggregate Layer 102.82 D 1.7 Ft. /oo . j0 1`' to 2.2 Cross Section Of A Mound System Using E Ft. A Be0 For The Absorption Area F •'75 Ft. G ~0 Ft. A L Ft. H 5 Ft. B COQ Ft. K 13 Ft. 01-0N F SAFETY A WILDINGS j, L 9O Ft. SEE CORRES NDENCE - 1 Ft. Force Main W 3 3 Ft. L_ Observation Pipe A ° 0 ~0 I~---t- M Distribution Bed Of 2 Pipe Aggregate Observation Pipe Permanent Markers y ~ Pd~ o~PPE~ s~E~~ ,Poos . Plan View Of Mound Using A Bed For The Absorption Area 2~Q~ipE D ~~jS.4 L Mkt f} = l~Ai~. Y w~ 7E f%w yJr'D r.~ /,'ic 0 SQ. 7- 4c " ci6 . r- 77 Page 3 Of • VOID o 1VI4 E wok 30 FT of 2 1'Uc ~oRcF YZKE SAS T ~o le Perforated Pipe Detail u~ORi'6A T fve UPI C vtiE P- VAC v 7-f •oA-1~ End View )Perforated End Cop) bye y~ PVC Pipe 1 ~o1'oce Holes Located On Bottom, Are Equally Spaced q X PVC Force Main w .7 /P PVC Manifold Pipe i Alter•iote Position of Distribution Pipe Force Main , i Last Hole Should Be /~l/G4~ Forms 2 i Next To End Cap End Cop Distribution Pipe Layout P 30 Ft. o •¢</aw F'oe / i X y~ Inches ' Y Inches H Dr ift'IitISTR~', I_A~3t)63 & NUBIAN Hole Diameter Y331 Inch PlafOAOF SAFETY RELATIONS D GUILDINGS Lateral " Inch(es) ' Manifold Inches SEE CORRESPONDENCE Force Main Z Inchf_s # of holes/pipe ~ Invert Elevation of Laterals /0s'~ t. !~/S 7-R1'13 v7"/oA) Pisc~4AO ye t1l74- k Eq c!1 14;rCk / 9. 36 • TO' j.1 WS T R i a U T/o, j 17 / s Gti. Ak'GE ,17-er"r" R 1j,?&0,P 3 7 y7 ~ a•S • Z!S E % d T.4 G D ~ •S Tit'i l3 v ~'/D.c~ D i ' S ~ ~-~P lr~ it''. 9' T~ off' SO4-00865 1 PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS PI OF ,C- VEUT CAP 4'C.I. VENT PIPE APPROVED LOCKING WEATHER PROOF JUAICTIOU BOX MANHOLE COVER 25 FROM ODOR, 12"MIN. ill w NI,)6,- /AM/ WiMDOW OR FRESH I AIR INTAKE 1A,4De/Er/i17~On/ GRADE I 'i"MIN. 7•0 ~ IB" MIIJ. CONDUIT /Ef/,+n. OA. /o/.o INLET PROVIDE I 14 -7 6 AIRTIGHT SEAL tn1 I i I v APPROVED JOINT IN A ~,~(V K I I I APPROVED JOINTS W/C.%. PIPE "I ~~,ONE , I I W/C.I. PIPE EXTENDILJ& 3' 01-f ( ( ALARM EXTEMDIUG 3' OWTO SOLID SOIL * II ONTO SOLID SOIL ON ELEV. FT. 1 {I- IN lUSTR:° I "A` lR & HU%aMnji OFF ~rl i ..N OF SATE tY "D BUILDI1 k D prC~c~ rJJ BLOCORRESPONDENCE RIStR EXIT PERMITTED OUL4 IF TAUK MAWLIFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE T MKS , MAMUFACTURER: WEE,~$ YJ.UG.L~-e ~~dD. iJUMBER OF DOSES: PER DAM //SD TANK SIZE: 900 '-'1 GALLONS DOSE VbLUME .4- ALARM MAMUFACTURER: LeVEL ~4IA9)4 Cd INCLUDING BACKFLOW: 477 GALLONS MODEL NUMBER: -b• U. L • CAPACITIES: A= A/ G INCHES OR 300 GALLONS SWITCH TYPE: JiE R C V R y IFl 0 A T" B = 2• IMCMES OR JU/ GALLONS PUMP MANUFACTURCR: ZoE//E~ a ~-/(I INCHES OR /~7r CALLOUS MODEL NUMBER: 7p a y2 ~P ir5 V D 111' A INCHES OR 30~1 GALLONS SWITCH TYPE: Fii5Y BAck M99CO0RY F(OAT MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEM PUMP OFF ARID DISTRIBUTION PIPE.. FEET -rAA9k SPECS + MINIMUM NETWORK SUPPLY PRESSUR~T,E~~. . . . . . . . . 2.5 FEET 6AC(A- I " Of' y{ P ttL + 0 FEET OF FARCE MAIN X 2 G2F/ooFtFRICTION FACTOR- ' 79 FEET "oA S Z.O.•S" ?ls. TOTAL DYNAMIC. HEAD = FEET „ RovA-Ip 3? INTERNAL DIMENSIONS OF TAUK: LENGTH ;WIDTH ;LIQUID DEPTH A 4-0486 S9 f!_ N HEAD CAPACITY CURVE 3 7/8--~-- 6 1/4 MODEL "98" 30 4 5/8 25 - 3 5/8 I 6 m + + U O 4 3/16 15 F ZI 4 ! i 10 R - 1 1/2-11 1 /2 NPT 2 i 5 _ i'• 1 0 U.S. GAI-LON5 10 20 30 40 50 60 70 80 LITERS I 80 160 240 0 FLOW PER MINUTL UW1 hr TOTAL DYNAMIC HEAD/FLOW PER Wr1UTE I EFFLUENT AND DEWATERING i CAPACITY 12 • _ HEAD UNITS/MIN 'I FEET METERS GALS LIRS :a - 5 1.52 72 ?73 - 10 3.05 at 231 ;i 15 4.57 45 170 20 6.10 25 Ds 3 5/16 Lock Valve ...J.f ' CONSULT FACTORY FOR SPECIAL APPLICATIONS i• a ;t a Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. !Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. 1 SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - -/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float ? 98 Series Control Selection switch. Refer to FM0477. j Model Volts-Ph Mode Amp* Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. r M98 115 1 Auto 9.0 . 1 or 1 & 7 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". ? 5. Mercury sensor float switch 10.0225 used as a control activator, specify N98 115 1 Non 9.0 2or2&6 3or4&5 098 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim• ' •E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10.0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For kdormation on additional Zoeller products refer to catalog on Combinmion Starter, FM0514; All installation of controls, protection devices nrd wiring should be done by a quaN- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO466; fvltechanical Alternator, tied licensed electrician. All electrical and r40* codes should be followed inclrrd• FMO495; Alarm Package, FMO513; Sump/Sewage Basins, FMO487; and .^:Implex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and ;r FM0732. Heahh Act (OSHA). RESERVE POWERED DESIGN For'unusual conditions a reserve safety factor ~s dnlineered into the design of every Zoeller pump. NAIL T0: P.U. BOX 16347 Manufacturers ol... iO:G , KY 4,',156-0347 O SNIP lP 70: 32E0 0 Millers Lane 1 ~ Aff y Louif, ide, KY 4(„216 UAL/'Y PS /NCF (5021778-2731 • FAX (502) 774-3624 _00865 Wisconsin Department of Industry, r~ Labor and Human Relations SOIL A E E V A L O N REPORT Page_of 3 Division of Safety & Buildings in i rd wi fC41AsS4.05 V~(tS dm. Code Ali COUNTY ~ 1~ ST. Attach complete site plan on paper not less than~8 T x 1 fi i'hes in'si " Plan r ust nclude, but CPO l' X not limited to vertical and horizontal reference poirdl M), direction, And of slog ;sale or PARCEL I.D. # dimensioned, north arrow, and location and dista~ tip nearestoa;-A: d ` APPLICANT INFORMATION-PLEASE PRIM` IC,.t~virA'fir0~ r REVIEWED BY DATE 11TY,STATE ROPERTY OWNER: i ,-PROPERTY LOCATION PROPERTY TI 'l~( MASS GOVT. LOT SE 1/4 5w 1/4,S 20 T 30 N,R 15 E (or) W 3 O N ~'~MAILINNG• ADDRESS LOT # BLOCK # SLBD. NAME OR CSM # ART OF 610 f C^C-V Cl ZIP CODE PHONE NUMBER EICITY (]1IILLAGE rRrOWN NEARESTROAD GIENrnooD 1~y Wt• 59'6/3 (715) 2&3--1/612 Gl~~wooD MwY• G- [ j New Construction Use [ Residential / Number of bedrooms _ Z' F [ ] Addition to existing building lkrReplacement [ I Public or commercial describe r Code derived dairy flow 3O° gpd Recommended design loading rate ' Y bed, gpd/ft2 • 5 trench, gpd/ft2 Absorption area required 2-50 bed, ft2 2.50 trench, ft2 Maximum design loading rate • s bed, gpd/ft2 G trench, gpd/ft2 Recommended infiltration surface elevation(s) 5a: P OA • 3 ft (as referred to site plan benchmark Additional design / site considerations S 1' TE .so r T A R I E fo p. A M ova D L&E`Ts ",4 " t) Par nt mater' Sc5 yo ~M&- s ° Flood plain elevation, if applicable It S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN F L HOLDING TANK U =Unsuitable for s stem ❑ S 2S 1:1 ~ ❑ S C~ El S B U O S O S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure Bound3y GPD/ft in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Roots Bed Yom`' erdi 0-? 7.SYR 3/5/ ;A i3 9~ ~s 7 s YR Y 4 5 / S Z ti, sbK n•,U f R a S 2 of 7 .8 Ge and B 2t `S- 2.S 5 YR V13 S 2,f s bk rw►'F 2 2 • t?L ft. 7.5 YR 71t e 54,E ~ car}T (C 6) i4 /0 A.) G- PEO 5 Depth to C S~ y 7S y R 51 limiting R 7. S 5 SC Z, 'F r 5 bk /w► i y. S factor „ SSS Remarks: Boring # O-1 7.S Ye Sly 15 1. s- sbk owu;2 c S 3of .'1 .0 F2 . B3, ?-t& i•syp Y16 IS 2.sbk .rhu`Fie CS .7 .8 Ground Bit- & -IS / o Y R 5/3 s 'R ' P 5c- ~ I S b ke A,%-r t' Q S r . 2, .3 /o elev. ft. 2G - 50 -7. S Y R 51-(o s Y R' s! • S. 0, S ns ' 6u E',~i~G GEiK 7 ED Depth to _ limiting 2 C fit s$S Remarks: CST Name:-Please Print Rd) as R r 2( Lt3 R I 'C, It T- Phone: 7/.~'- 3 J06 J03- Address: Co5-.5 oi/JL- L RD• I~00Soa 60 t. Sypt (o y-/~- ? Cf-7,_AJj f/ Signature: Date: CST Number: 4L_ 7,5 >lt.e, Y /t~v lF /SX /c 4P /i4 e e-, -t eA., r- s!/ s TEiy 5 . .20 ORIGINAL 4J,,// ~1Jil eG~ 7 6 /9,6 ~'ll/pUEI> .4/D~vl~ Gov U~7( slopE . e,.7,0 yq u `Q /f OAz l /t S /00 S' 51:6146 13Ee1fzfS c c, :57X 9?`~-5 C C PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. #I Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed March o- y 7 S ye 31y - S 7 77 6,- ~n vf~ 4 S 3-F 7• 7•5 VR y/6 s/ Z ,f, At es . s . c Ground - ZS S YR ylee 15 f, sk XX CS 7 /oolev ft. 5-SS' -7.5yR 51 '2 SCE 2;f, SbK nnnVfl-N N 5 vie Depth to limiting factor n Zj ss s Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: can uoon,c ncmrn 9 0 NoT~ ExiST~N~ W~l( liE5 S$Pq 3 P1 V. WFSr OF Nci,E Cwt1/ Nor Shojo AJ) • 2. Elcisrr,j,& ThakS (SEpree 3 t~RywE tl~ wtll QW- R13/rNl~oe~e~ re`" rLH R Q3,o3 (2~ wD TA'JkS ARE- of uNl«,owj Si2E b CovpiTio.iS. • PR!!i^~~►L'LD iN NoU- Co►a~Li^AsT Soils will h l S c~ (3 E a f3.~ a do.~ e D ~ Sc~Lt ; t = yo • = /3,4~~tioE p,rs 0 (3, /oz . P y ' old vRyw~/ f3 102. ~yr~~ T 13 3 /oo. ~8 t Mnuup SySrEM EteugrioA ~y Zo9Q k'/ .10 SAND = loy. 5 2- ' yp•t f3eDRM EXeS rjA.5 4i k} E e2 Re•pu«r ~ ? fl FTer2 F(Re (a V 1912 Q, Z)r o ~ J N ~J • ~3G' /3A( Sa-r N / ~rar or- f ~E l/~~ov 0 IN S~ ~ N /tl0 . d h b1 SLL, 9y CoRA-)eR of W 4a AcRES c of y~ ,qc~~s . . a. /.~rEST EDG-~ `a I 0 W d R I-Irz h vi v` A O y \ n N G W' r ti b e ~ ~ ~ ~ Nq . -mow ~ ~r: N rn o N ri t ~ Q o o w w a. yb , .p h ~y m c y rn Z ~Z din y: U