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HomeMy WebLinkAbout040-1188-90-002 STC - 10 4 AS BUILT SANITARY SYSTEM REP OWNER ADDRESS" / fi(`dz9~/2~~~~ Z U E-c~Z (~'vzz SUBDIVISION / CSM# C C C (~~-S LOT # SECTION_-~~T-I N-R_W, Town of © / ST. CROIX OUNTY, WISCONSIN PLAN VIEW HOW EVERYTHING WITHIN 100 FEET OF YSTEM - ~ r a ~ o 2~' LL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. u`2o~1994 RECE~~EID , ~~7tl BENCHMARK• .C4 wotG,-er- !Fto ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: 4 jZ Setback from: Well (V1~ House ~ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length Number of trenches J~ Distance & Direction to nearest prop. line: Setback from: well: House Z b Other ELEVATIONS Building Sewer ` KST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold ZBottom of system I Existing Grade ~5L Final grade i DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER:/`' G INSPECTOR: 3/93:jt "WTSt~~s7YepartrfSBnt~gt~nutP8 9 ►`+pj ATE~A~E 5~'STEM odridge onri un y: Lpborandl-IumanRelations INSPECTION REPORT Safety and Buildings Division yPer (ATTACH TO PERMIT) Sanitarmit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: STAN Troy CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION j ELEVATION DATA A9400093 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 71 Dosing Aeration Bldg. Sewer 5 R?~, Holding St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet , `fd,_~ _7 TANK TO P / L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic > ° NA Dt Bottom d Dosing NA Header/Man. 9a. ~u Aeration NA Dist. Pipe ~•~5 R~ Holding Bot. System o PUMP/ SIPHON INFORMATION Final Grade q, 9 Manufacturer Demand 3 ti , Model Number GPM TDH Lift Friction Syesatem TDH Ft Forcemai n Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Leng I No. Of Tre es PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO t€ Model Number: System: j,s s4 vZ's OR 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 Systecgs Only Depth Over Depth Over PfV xx Depth Of xx Seeded/ Sodded xx Mulched -No Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ Yes ❑ No Ej t& COMMENTS: (Include code discrepancies, persons present, etc.) "Zile LOCATION: Troy.36.28,1.9, NW, NW, Lot 62, West Woodridge Drive or L } I 77- r Plan revision required. ❑ Yes ❑ ~No -A-, Use other side for additional information. t' k'-L~f/ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY l .o.~.~„a......,,~.,,e. e x _54- Ot STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ao~s~I D 8% x 11 inches in size. Check if revision previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY O E ) ~j PROPERTY E~RTY L CATION 7 /V S T(, , N, R Z:2: E (o PROPERTY O S M ILING ADDRESS LOT # BLOCK If '77 k~m&tAe Dr, 6-L I CITY TAT _ w / ZIP CO Z PHONE UMBER SUBDIVISIO NAME OR C NUMBER 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE ❑ Public K-1 or 2 Fam. Dwelling-# of bedrooms PARCEL S9_,4QWW OF: 7"/ 010 &V A 6L, AX Nu ( ) 111. BUILDING USE: (If building type is public, check all that apply) 1 _ OQ 1 ❑ Apt/Condo ( l 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0-hiew 2.E] Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 220 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/da q. ft.) (Min./inch) CE~LEVATI N Z 3 • ! Feet / '71. 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 Holdin Tank El F1 I F1 L' VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibili for installation of the onsite sew a system shown on the attached plans. Plumb ' Name (Print): Plumber' ignature: (No S ) MP/ o.: Business Phone Number: 0 e7 7 2 f Plum s Addre treet, City, State, Zip Code): w~-( ~~✓1 IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved San' ry Permit,Fee (Includes Groundwater Date Issued Issuing Ag t Sig (No ,.g,~ I r roved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I I SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber ~T K IPf9TRUC ONO + 1. -A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration d-rte, and at the time of rc! ewe I any new criteria in the WisG,(.)s!sin Administrative Code will be applicat!e. 3. All revisions to tt= r permit must be approved by the perrni' i; . wing authority. 4. Changes In - wr 7hip or plumber requires a Sanitary Perrr.' T ansfer/Renewal Fc r ; "3901 to be submitfied t- i!a ,.-.):lnty prior to installation. 5 Onsite ::a _ je systerrls must be props ri y maintained. The v tank(s) n-,...:t ° r ,,-d e licensed pumper" whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsitp sewage systeni.'coritact your local code si.drrtriistrator 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 tare number(s) of where the ystem is to be installed. ll. Type of building being served. Check only, one and complete # of bedrooms if 1 or 2 F"al:.,.iiy Dwelling. III. Building use. If building type is Public, check all appropriate bc.ees that apply. IV. Type of permit. Check only one in line A. Complete line B if pelrnit is for tank replacer; ant, reconnection, or repair V. Type of sy;atem. Check appropriate box depending on system t} pe. VI. Absorpt'rjrt ysterr information. Pr'%I e all information requested in ,ft1 V11. Tank cxr .?tl;,=! :'ill in the c.apa ty e,lry new and/or existi i - ta" ,rlrn5er of tar+k:, ;in name. prefab or site constru.^tt',_ for all sup £i7l'i 'ri and holding ti.nl,:., , tnis system. Check ,,,"ovals received e:r~,jy n approval fru~ : DIL_HR. VII?. Rti Por'~It? sl-ltement. installin< pitimt,,er is to fill in name. -5 je r,;!rnber ,vi4h ~~l>r~r. tr r p-:fix (eg. MP, etc.). lr ^nd phone number. Plumber must sign appli.)n form. IX. Countyi Der:";:: It Use Only. X county!Df_ ,r1,;e Orly, L?SY'r i" " - `c +`;-1tions riot Sr ,?IIBr tian 9Y2 ns I C -Jlrlg: plot pkar, dro'wr': to sca'. !?Old="^ r i?her ^anks, blitidin, tkjWls, service, $trr +ft S ti :r .n siphon tank- licrr9blaiiUn t O r_' p. ia= s1 iL~li j /ciu { •c r: _y„ "Et SVSiF'm iun of the buiit,'ng t) horizonta - C) compi(-r, " sp •cifi~_ations for puntps and controls; close r: evation ;:)ss, pump perfcrirl m.e curve; pump model and pump manufacturer; D) cross section of the soil ab,:,orption system if required by the county; E) soil test data on a 11& form; and F) a'41 sizing information. GROUNDWATE14 SURCHARGE 1983 Wisconslr Ac; 41 ncludod the crQatlon or ':i = [ S rr es) fc r a nur-~:: 'r r{ I -.tn~ FJ~_::_C;re5 V2 t'~1~ h r., =:r. -.;feet r:`^!_f r1 C{1Ar T ' c.,. tA=aia-r'f"v SBD-6398 (8.11/88) PLOT PLAN SCALE 1"= 30 ' ,i 21.D6L OR. w(- ZT- o 4. 2B' M- boo.W ~T P of kAl t. s r G~4 III ~ I~ I ~ i m t ~.az y 8.3 ~`NT 6 Z LTL gay. ►oc.ZB' Y f 4 ' C~oSS 'S~c..TionJ C.o4-- 719 Ley! 7N Sal" / L DART` f' Ca 6 P1 PC y' ~gGlc ,n, o flf de ~ 6 b ~3 f . F 1 I Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page k of 3 Labor and Human Relations y Div f rt of Safety Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S T. 0-MG L X 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. o y.0 - t 1 B ?j APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION a V 1 k_T too L GOVT. LOT 1vW 1/4 tJW 1/4,S 3 6 T, Z8 . N,R 19 E IV PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK If SUED. NAME OR CSM # . 3 13ux 1 6Z _ dArvr-TLL06It- me S CITY, STATE _ ZIP CODE PHONE NUMBER ❑CITY []VILLAGE OrOWN NEAREST ROAD 1.wCHtLLS~wl SvuZZ (~ts)~Z.r_zrZZ TRo W~oD2tD6t OR . YA New Construction Use ( Residential / umber of bedrooms 3 [ ] Addikn to epstiwg building i ) Rephoernent Public or commercial describe Code derived d~Ily >foxr S~ gpd Recommended design loading rate o 1 bed, gpolft2 2. 5 trench, glxW2 Absorption area required t l 7,5 bed, ft2 q-o 0 trench, ft2 ' MaAmum desgri Ica ft rate -2.-q bed, gpollt2 0. S trench, gpdft2 Recommended Infiltration surface elevation(s) ft (as referred to site plan benchmado Additional design l sb considerations S1-3:e ` &DS o-., Pf 'c 3 o r- 3 Parent material cyvZ+~-► R S N Flood plaid eiewafion, 'If applicable 1~ • A , ft S = Suitable for *1 em 00we 'rIO k MOUND f44v NO PRESSURE AT43RADE SY8 W IN FILL HOLDNG TANK- U=Unsurllal*I& systam ®S ❑U IRS ❑U 'm;5 -❑U [as ❑U ❑S ICU ❑s: SOIL DESCRIt~TION REPORT Depth Dominant Color Moines - Structure Consistence Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Roots Bed TOM o_t2 10`LIZz,LZ - Si lCabbc 'yV%~ti cS o•Z o.3 Z V"__qS l~ `~R 3!L - s t Z F5~1T tin cs o• S o. Ground 3 14 3 -8 to `fR 3!~ - S` g~S 1 CS bK ),nu`~h o•5 elev. QS-9 ft Depth to limiting factor ? az Remarks: Boring # O-l1 ~O`1IL LlZ S1~ Z~SdVC In CS - o.S 0.1e 2 Z I7_y0 lb `C2 Jl6 Si Z`F S~>~ 1Nt'Ft- aS _ o.S n•~ 3 qo s 3 m`i 2 Jt: - S 1 l s e k tin U `F►~ S - o o. S Ground elev. C4 3_ g 1 I `i 2 5l/ ~S O s~ Vh - o. S v. L 9:4 ft Depth to .1milirg Sly T-1 Remarks: CST Narl'e.-Please Pmt Arthur L. We erer~e 715--:425-0165. eg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 540,22 Signature: n Date: CST Number: 93-1f$ 6-tS-9I ,j M00576 PROPERTY OWNER CUkUL`rLl BUNT' SOIL DESCRIPTION REPORT Page of 'S PARCELI.D.# nqc) - 11,9-g Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench I o-L~ z Z - s Z~ SV m h ~ z ~3-uZ ~o`tcz ~1L - s t l z-~ s bk-c~- C- S o. s u. 6 Ground 3 4Z_5 Z. lo'-i. 3! L S CS plc M U'f^t~ 0-S o • S elev. o K tZ -S! s gZ-- `1 ft. 14 Sz_aZ L% Z Y - S cS bk 1'n U'F} o• i o S i Depth to limiting factor e Remarks: Boring # Mv..>~•.. o_tO tiu'L CL Z[Z S1 Z`Fsb~ wL`~r•. cg _ o.S~o.6 y},~v Lb -3'7 1 Ll `-L lZ 31 C $ l ~ Z S bk 1~'1 ~ t- G S - O . S ~ V • ~ 3 - 3~-53 I,b'~.(Z ~!G - S ~ lc-S~~c y,., ~ cg - o• o. S Ground elev. y S3-51 LbLf fZ V,66 - s $~S. 1~5Uk yr - v ~!;v•S ~l 3 • L ft, Depth to limiting i factor > 43l `r Remarks: Boring # ws> r 1 0- t O ~t tZ 2[ Z S i 1 Z in s b Vt V'l ~h c S _ o, s 0.6 1>Y 5 s 1 Z F 3 e t~ Fr e S - o. S o. L 3 qS-SS to~tZ 316 S lCSbVT tnU`Fr., cg O,q Ground gel v,l ft. L4 Ss-sz Lo-i iLy16 - Sl~~s l~sbk M vf,,, LI, Depth to limiting factor t E3 Z ' ' l Remarks: Boring # L Ground elev. ff. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' -voo~2lDGL OR. WL s T ! o z,9 m- goo. w hiP of $uRt ~ 1t?'l. ETA 1}01U~ 11- ~lcTs'TYt L e~ - et On.1 o►a 8o'Trak'S PfFP1LOx. grt-e1z o ol= S ~Dl~u~ _ ~aoPoS~ [ivvs~ e<- 9 5 $ kr. 0. 3 b 9 8.1 Z Sr ~ JO r r 00 9 Ip I 9 •g s etgy 1 -M 8NE- trT LetvaT So' RI WI S~iST~~ PrCte~A s •L ai y a,3 --Z e1.4, y s- 1~oTE TU _ 1 N 5-1'x(=C~~2 8~ 1~ 13E W-1 lv 36" '=RT _'I11_ _ cx. iS 1-U h GE _ L/v s1*vLk-M 1'%- 'Orll- ZM1wc~ _LU h tvU~ uR Ex, G _ c S77c, c77 obi F _ Tt2 C- ti+ rFR w s TA-c FLU 18p FL~T'6F 5 ' +s,O b T1Z~~?.~Clt ~s ASE \Z R L+_►R- 1- . 6.`RPftMT, 24 Tb 3lm" 61F~ ff T- 7~F E ~Uw,u S LO PF Eb cc - . C73_ ~c°~ 6-15-93 (715 ) 4L-0169 M00576 CST Signature Date Signed Telephone No. CST # SEPTIC T201K HAIIITE i),1 Ci; 1,G St. Croix. Count- )64t7ER/BUYER 77 FI & E 30 ~ . LOCATION :11Ll/4 , TOWN OF: ST.•CROIX COUNTY SUE, 'JIVISloll: (14K PC ~6,~f. A 6P -C-5 LOT N0._ j Improper use and maintenance of your septic system could result n its premature failure to handle wastes. Proper maintenance l_i_ts of pumping out the septic tank every three years or °;rer, if needed, by a licensed septic tank ;pumper. What you Drat 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year exj'.ration. 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 DIR. Certification form ri-t be completed and returned to the St. Cr,;lix County Zoning dicer within 30 d_-ya of the three year e,•liration date. SIGNED: DATE: St. Croix County Zoning office 1. elt11 St. - son, WI 54016 .s tt • ' 'i STC -.LOO 5 application form is to be completed i tlle o~til~er(s) of the in dull and signed by will only result in delays aety of being developed: Any inadequacies the permit issuance. Should this development be intended for resale by owner coatra Douse), then a second form should be retained and completed the property is sold and submitted to this office leted when appropriate-deed-recording. - with the owner of property Location of property/ /4 AA- Section, Township /41 ~0 TaN-R W Mailing address 5 G~i ( oa Z Address of site ( f JA AA Subdivision name 12-«D 6r /-lL~'~ Lot no. Other homes on property? es y o Previous owner of property G 1 CC /C. ZCS Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Ye s -4No Volume and Page Number of Dee s . as recorded. with the Reqis ter INCLUDE WITH THIS APPLICATION THE rOLLOWING: - A WAitIUJITY DLED which includes a DOCUMENT NUIIDER VOLUME i NUH13i-, t & THE SEAL Or THE IZ.CGISTLR OF DEEDS. ~ In addition, PAGP certified survey, if available; ;would be helpful so as toion, a delays of the reviewing process. , avoid referencoc to a certified surve a If the used de~urvveyey Nap cription . Map shall also be required. y p~ the certified su tF • PROPERTY OWNER CERTIFICATION 1(wc) certify that all statements on this form are true to the best of mY ( our ) knowledge that I (we) am (are) the the property described in this information form, by virtue so of warranty deed recorded in tli Deeds "f ice of the Count f a [ as Document Ito. y Register of own the proposed site, for the sewsge disposal ~ and that I system presently obtained an easement to system or Z (we) the construction ofsaid rsnstethe m above described property, for ount, and the same has been duly rNeo .corded in 2 lie office of County Register of deeds as Document .19nmtur of ap~l can Co-appl cant Date of signature • Date of signature ...,...,m~.....,~,. WARRANTY DEED TH16 so-ACE O[K11VtiD .olt H[COnD6166 DATA STATE BAR OF WISCONSIN FORM 2-198X _ 1.5 8 vot 1073 OFTICE • Eugene •.0 . Larson Don D . Kru er : and C, i f^ " Lawrence-M.• John son,..Jr...... T7 a uali y•'•'•'•"•"' tt~rRra,rD II Built •Homes 94 G'_':'CE Co. APR 13 1994 conveys and warrants to •,tanley. E. ••Ramberg •and •Ma~i..N: i 3:40 P F3r~ivb~xg.....huSk2s70.t...14...~right .of.... t"~ survivorship... li » 1 _ I. ~i '11[rYaN rti_."~ it the following- described, red •esate In ...s t cro i ; ............county. _ !f sate of Wisconsin: Tax Pared No: ii Lot Sixty Two (62), Oak Ridge Acres to the Town of Troy. The above-described property shall be used only for owner-occupied residential purposes. $ A . c) FEE., Thu is..nQt homestead property. (u) (u not) Exception to warranties: easements, restrictions and reservations, if any, of record. Dated this day of April 9 4 ;I QUA Y BUILT S 10 BY: r . ......................................(SEAL) 4SEAL) ! . uclene••O: Larson a Lawrence M. ohnson, Jr. i! . . t....1 (SEAL) f (SEAL) . Don D. Kruger e AUTHRUTICATION AC$NOWLHDOMENT Signature(s) STATE OF WISCONSIN E;eL.R:...Couaty. es. authentkated this ........day of ie Personally came before me this day of ........av.f.d 19.q.Y. the above named w rtn TITLE: MEMBER STATE BAR OF WISCONSIN 1 (If not authorized by 706.06. Wu. Sata.) to me known to be the person who executed the 1 foregoing instrument and acknowledge jhe same. THIS INSTRUMENT WAG DRAFTED BY Russell E. Berg, Attorney at Law River Falls, Wisconsin 54022 v"""`°'•a~••-•~••~`1"•v.••••-••..-.LCSt4t@af tA !3 ...trvls ..County. Wis. nS! (Signatures may be authenticated or acknowledged. • Notary Public Commission Is permanen (If not, state expiration 1 are not necawary.) Bout date 19........) i *Names of Pomona drolut: to soy eavacltr ahoulA h• ton•A or orln..A 1..6,,,, tFeb •I..,.,.,.._ - Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ~ of 3 La,Mr and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code ~ COUNTY s T• cR0 l k 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. o q 0 -1,1 B ?j -CID - Ou L APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION v~ vN*N L \ `M aU 1 LT H v L 5, GOVT. LOT tvW 1/4 IJW 1/4,S 3 6 T Z6 N,R ) 9 E (or l PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # . \_1w UTL-- 3 13ox 1 C~Z. _ e~1~RtpGC 1 c-1Z~ S CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE TOWN NEAREST ROAD 1ZlUtj'V_ F:h U_S,IQI 54uZ-Z (7tS)~ZT_Zt2.Z 11Zo W~oDR1DGk ~Rivy New Construction Use [)Q Residential / Number of bedrooms 3 [ ] AdditiQ`n to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow L-\ S\3 gpd Recommended design loading rate o y bed, gp(W S trench, gpd/ft' Absorption area required \ 1 Z S bed, ft2 9 0 0 trench, ft2 Maximum design loading rate o • y bed, gpd/ft2 0- S trench, gpolft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/ site considerations SQ:e 1~T~ cati l~r"c GE 3 o t= -1 Parent material ovT~ R S N Rood plain elevation, if applicable N • A . It S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for Stem ®S ❑ U [NS ❑ U IRS ❑ U ff S ❑ U ❑ S C91.1 El S WrU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bcutciary Roots Bed rend \ o_lZ vz)-I.IZ-ZlZ - Si lCa\~k lrr►'F1' C5 Z. Q.3 LM Z 1Z -~l S L D Li P_ 31 L - s t Z F 5 k Vn c s G- S G -L Ground 3 uS-$ 10 `I2 3!6 - s~ $~s \ CS bk rnU~h - o.y o.S elev. Depth to limiting factor > t3Z Remarks: Boring # Q~ Z) 11 TZ 2 Z 1~-40 luK2 3/b Si) Z`F S~►►~ 1Nl'F4~ CS _ o. S o.Q 3 ~l o _S 3 l O R 316 - S\ 1 O-S b k Vn S Ground a X14 elev. U S3_$! X0`72 4~/ '~5 o S°) _ o. L Depth to limiting oo ✓ i ~,''j~ f ? for f actor T ? g f S k i 1 Remarks: Q T Name:-Please Print Arthur L. We e r e r Phone. 715 -4 2 1 q Address: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 540.22 Signature: Date: CST Number: 93- 1►$ 6- IS-9-'s M00576 PROPERTY OWNER (S-U+A-L`t-4 BUtL r SOIL DESCRIPTION REPORT Page ?--of 3 PARCEL I.D.# y~-lb - lL$b' -00 -z- Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trends 'tC ~t2 31ro s t 1 Z~ s bk ►~'Ft~ ~S o. S u. b Ground 3 LCZ-S Z. to t lZ 3! L S 1 cs ~k hi U`& C- o o • S elev. (LS a i. `I ft. Sz_ sZ Lu ~tt► Y t~ - ss_ S Uk M u'F►- o. L( o S Depth to limiting factor ~ 8Z Remarks: Boring # ~fi~~.:<:> ~ O- t l7 1.0 ~ z. L Z ~ S 1 , Z `F S h~ ~ ~ S - n , S o • 6 y 4 Z io3~ ~o~t2 311: ' :ti - S 1 1 Z1Sbk vn ~l- cs - o.S u 3 .jam-S3 lb~I.lZ 3!L - S ~ 1cS~►•c yr,U-~„ cg - 0~( o.S Ground elev. y s 3 _a ► t c~ P- 4116 - S $ `~S 1 c S Uk Yrt v 'Ft, - v' S 9 3 [o ft. Depth to limiting factor > 43l Remarks: Boring # S 1 0-~'~ lO`C2 z CZ S Zht s At'C`(;►~ cS - o. v•~ ti Z. k3-y,S LO`-t2 3[(, - S 1 Z Fs 1Nt'~r eS - o. S v, l 3 4.S-S5; ~0-j 2 316 S lcSUk mv'ft., cg p.~(`o S Ground elev. t4 S3-8Z 10~lIZ~Il6 - SI~~S Z~sl~k wt v~,, - o o.S cjg• I ft. Depth to limiting factor az Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: S13D-8330(8.05/92) PLOT P LM Page 3 of 3 SCALE 1"= 30 ' lob• zs, you , p' Oti ~vP OF ~Rl~ 1tt~A►W~L P~cTsTRL WauSe 'M - e- 00, 1 0►.~ $o i Tp1H ?vP?MML • 9 O l~ 01= S~DUu~ /r~[zoPUSI~ ~OV3~ kz-~, °L t 6 » z S' m rn tie .e r 3.s tTLgt4 I w 21.1. 'Ri 9~ 1~T' I Lt--ftsT So' Rla )-1 s I 'L 6~ IL aZ y e.~ _ a-z E-. 014 y s- -N) OTE TO l ),s STR L LZZ lf*tb _8qA lv 8~ Z.,4 3b" D k T TbF DU-A.)S LUPQ LN S'ffrLl ~R ZD D~TCR~'1JKle S'-tS`IZ'~ L'Z~ ~`Rlw ~v21w C, Coru S7~.c~ c7-i UlV F T1Z. E)v C h} $'S InIZL lti s TA-tLLU 18U F <-zV T- OF= S ' w4j' D E T1ZL~.►Ct~ S A-i~L~ \Z v ► R~ 1~ i.~, . 6 `A.PITLT-, z4T'o 3 6'' D Tei- ff r ` (T -001., S w Pt L-M c , C)3- IlOC, 6-15-43 (715 ) 42q-0165 M00576 CST Signature Date Signed Telephone No. CST # Parcel 040-1188-90-002 03/01/2005 05:01 PAGE 1 OF 1 F 1 Alt. Parcel 36.28.19.815 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * RAMBERG, STANLEY E & MAY N TRST STANLEY E & MAY N TRST RAMBERG 77 W WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 77 W WOODRIDGE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: 2237-OAK RIDGE ACRES SEC 36 T28N RI 9W LOT 62 OAK RIDGE ACRES Block/Condo Bldg: LOT 62 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/04/2000 617906 1488/229 WD 07/23/1997 1073/588 WD 07/23/1997 1044/69 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 27607 215,400 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 35,000 180,800 215,800 NO Totals for 2004: General Property 0.000 35,000 180,800 215,800 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 25,300 167,100 192,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 303 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00