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HomeMy WebLinkAbout042-1016-70-000 • i I STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER - -'(2 l/ 445 1/0 A4DRESS SUBDIVISION / CSM# LOT # h. SECTION~TN-R, Town of (~Qn ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - ~ S7f 1 S' i 10`6 3s 91 aa- 7 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r . r BENCHMARK: 'Z/ ego- 6d ~a D ALTERNATE BM: t1~rx~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: C,U gg.A4 (}~,0 AhA Liquid Capacity: 1906 Setback from: Well House r Other Pump: Manufacturer Model#-" Size Float seperation 14 Gallons/cycle: NA01, Alarm Location AIA SOIL ABSORPTION SYSTEM Width: f Length S-7 Number of trenches Distance & Direction to nearest prop. line: ZS-/ Setback from: well: /House Other ELEVATIONS Building Sewer ST Inlet: O~ Q ST outlet 00, PC inlet PC bottom Pump Off Header/Manifold Bottom of system UAW- Existing N ~3.sD, Grade Final grade 'T%Do~ .4 a. A 03 4 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3 s~ INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety an~Ijuioings Division f (ATTACH TO PERMIT) Sanitary Permit No.: 'GENERAL INFORMATION Pejpgt}ti6er's Ot oAN ❑ City ❑ Village Town of: State Plan ID No.: Warrp-n CST BM Elev.: r Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 2- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Gr Benchmark ?`a s s Qd, ~5 r Dosing~~- -D'. l 17 Aeration Bldg. Sewer Holdin St/ Inlet f 911 ,E TANK SETBACK INFORMATION St/,,Wt Outlet Vent TANK TO P / L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic NA Dt Bottom Lt7 Dosin Header/AtTaR. Aeration NA Dist. Pipe I L ' 9"/37 Hol Bot. System ~3. ~d cp PUMP/ SIPHON INFORMATION Final Grade y 3 Z' s~o7 k, 7001 y,.7,_ , Man cturer Demand e Model Num GPM r TDH Lift Frio S stem T Ft LJ' / ` ~S r Forcemain L Dia. Dist. To Well S SORPTION SYSTEM BED / TRENCH Width S i Length 7 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI EN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA Manufacturer: INFORMATION Type O Aer 7 CHAMBER r e Num er. System: t ✓ e >Sd /d6o 1>/ CO' y¢- OR UN DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake Length -20 Dia Length I Dia. `f Spacing n`~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System y Depth Over Depth Over q xx Depth Of xx ed I Sodded xx Mulched Bed /Trench Center Bed /Trench Edgesr, Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)= LOCATION: Warren.7.29.18W, SE, NE, Lot 3, 107th Avenue Plan revision required? ❑ Yes [lo / Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION 713ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY S7" c Ras x STATE SANITARY PERMI # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ A 8fX 11 IrCh@S in size. 400 Check if rev sion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Y4 N &/4,s -7 T , N, R/ g E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /o b oo 6k JQ v P. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER w4 W„ Yoa 793.2% CSM q 5O ~v Vol 9 Jp AYS II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : /f KR E NEAREST ROAD _[3 CITY ❑ Public 91 or 2 Fam. Dwelling-# of bedrooms.! P R EL AX NUM ERO 042 _la 1 / -16 III. BUILDING USE: (If building type is public, check all that apply) © 7 / 0 O 1 1:1 Apt/Condo ! G ~9 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. F261ew 2.E] 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 - 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 9 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. SYSM~ELEV. 7. FINAL GRADE LI ~,D REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEV~AoT~ION d l01 .T *70 a P3 l4 ~.o Feet 7 X 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 strutted I Septic Tank or Holding Tank COO Q QE- K.S N Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPR W No.: Business Phone Number: ir7cl..~~-~= /~ec4~ y i 11 e ~302~3 ~S 7 419- Plumber's Address (Street, City, State, Zip Code): 91 _7 '2 IX. COUNTY/DEPARTM NT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued Issuing Agent Signature (No Stamps) ,tb'_}!1~ Surcharge Fee) pproved ❑ Owner Given initial I Adverse Determination OU 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. . 2. Your 'sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed. pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsife sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-203815. To be complete and accurate this sanitary permit application must include: 1. Propertk8wne~'s nitme-and' mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only.. Complete plans and specifications not smaller than 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) a bs'izing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) = - eueuRTro~S - ?6, 53, f33 Q(o.~0~ sb !o"t " o~Rro~ LA a4 IDIT -5 $b0 I Q g),O0 0 > 2-0% T, - "EOnR s opus DER `s ys r, 17 J V , ` ut IS, o 1 3 ? am # 2 So GG£S-teO ?fPE~1c.(,. ` sEr r/- -y3 LAY OuT S ffO"Aj SG 70•zs' 9{ 4 ~ o00 ; f ryAIA e 3 ~,rrro~ %s sh~•~vEv s~. ~8 StAkeJ OOT I C~vA,e T. el&uAT1'drJ /oD,Q ^LTEP,.NTC SEPtrG ~4~£•~ ay wsconsirt.D~~ertr F4t of endustry, SOIL AND SITE EVALUATION REPORT Page L of 3 L• abor and H~xnan Relations Dlv~ of Safety a Bindings 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 Rol* not limited to vertical and horizontal reference point (B", 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 . 13/Pi ~4ti C O GOVT. LOT $E 1/4 AJE' 114,S7 T 2.7 N,R 10 E (or O PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # I o4Co too -ac. hue. 3 CSA4 41,?06 PZ. Uo/. 7• P 7 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE 2MN NEAREST ROAD ROT3ERT S w is . 5 yo z. 3 (WO, 3 3 2- 9 6v1-(-RRC41 /077%, 141few Construction Use [Residential / Number of bedrooms 3 [ 1 Addition to epsting building I I Repboement [ I Pudic or commerciW describe Code derived d* Clow y5o gpd Recommended design baling rate • ~ bed, g0V • ~ trench, gpeflft2 Absorption area required &Y3 bed, It? 5-4 3 trench, 0 maximum design baring rate . ~ bed, gpo* _'0' trench, WW Recommended infiltration surface elevation(s) SEE' Pd-. 3 It (as referred to site plan benchmark) Additional design /site considerations ?dS G T!'E~ G(4 t: S O N 510 EG w/ t7 R o P 13 o x 2)1'S T R i 3 y j'/off Parent material SCS S 1 t ~h E T 3 }t FTE K Flood pW elevation, d app6rable 4,1,r1-- ft S - Suitable for system CONY MOUND &GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANG U = UnsuiMdble for system 1 21- ❑ U ❑ S ou, 7 Ca5' ❑ U Cr3 1 fa-fr❑ U ❑ S _Cxesgeotz- Slopes SOIL DESCRIPTION REPORT GXe55/k5l~_ SIcpF Boring # Horizon Depth Dominant Color Mottles Texture Structure ConSislerice BW-d3y Roots GPDHtZ in. Munsell Qu. Sz. Cont Cola Gr. Sz. Sh. Bed Iendl A 0-8 /OYP- y11 s./ 21m. 5hk /MurF R cs a,~, • s /(9 U 9 C3 8--13 to YR Vl y S// ~.,w►,~b ~►~R os 1~F • S Ground C + Z3 - 33 7.5 y R 5/<. S , s of 1L • ? elev. It. CL 133-70 /o yR S/F S O C.61 A- .2. Depth to limiting bc1or .y i3 a Remarks: w Boring #I R 0 ` j o yR Y I -~;;1 , s / z n.1 skje v%uf~ ~ S 2.% . 5 •6 13 Q, 15(-15 /0y9 yly Si i 56k 'FR CS l 6 • (3.z IS . 2) '1, 5 Y R 51 $ 2 nH S hK R CS If .5- 44 Ground elev. It C 21-Ty 7.S yR S/Ce s 0~ 5 cQ~ - • 7 1 Dt,'pt i to limiting Wor Remarks: T Name:--Please Print P 0 5E1kZT 14 LB R i C. 14 T- Phone: 715 - 3 P4* 9 I 9s Address: G 5 5 C)' tzel L RQ H 006,0 &0k S . S11014 r joo. 1- 13 cs rM 2 Y 8L Signature:, Date: CST Number: I,oTE - To BEST fACiII'-rATG' 6WAp*p 'S f3LLP~ . pRe1t=pezc-PS - eRr&iaAL, Sol( _tMST Ale EA C S,,ee PE"P0P_ -r oF'. I- Zo-S2 ay C S r 3 y y 1 w .At S To 0 tit' G-G.. 3 o v c.u A oru F R t= o u I' R>ED A L- Ft - p cz~ ~j [7 EU ('G~ In-t ~o v r s v Se . rt'I~ l' S ~U SDi tjE-S T ^ k E,a~ W(J I I3 ~°t-sFk ~a T ' . 111110"AT1f OWM (3 . G it O SOIL DESCRIPTION REPORT Pap .7-01 3 PARCELt). # SS /1 'I 8 06 9-a- t 0 f-- 3 Vol. 6 • s"7 Depth Dominant Color Mottles Texture Structure Corsistenoe Boxr~ry Roots GPD Boring # Horizon in. Munsel tau. SL Canc color Car. Sz. Sh. Bed 3 0- joyR y t s. 2, All. S k 1+ VP P, AS 2,~ . s • G y_ 15 10 y R y y ( 2,,~,, 6blr Iw►f k cS f .S Ground C ItS-30 1.5 y R s/Co S 0, C', s d St. cs • 7 .8 elev. C 2. so 7s VIZ SIP S 04 AA, s d eS - • ? • 8 Depth C o a /o yR 5/ S p, C, s de ~2 - 7 16fing > 9D~~ Remarks: Boring # Ground elev. ft. Depth to Ong laclor Remarks: Boring # Ground elev. ft Depth to g factor Remarks: -Boring # cli Ground elev. ft. Depth to kMng factor 11 ILI Remarks: con ooonio ncjno% /O 7 t - euEU~T~'oa5 - Sal 20 s ~~c~/foF ATS e6o T slopes a rR y S \ 3 s,~ J ( Sys \ 670 I r , 1p \ h 3 T ~M SuGG~STED TPEA36t, SET -y3 LAY 00T S HVAAJ STEEL Pipe- Z-IEUhTf0.1 g~ g0•zs' ,r/ A1,4 A r 9R~pos ric* 3 i StAkFD OUT ~ ~ HotirES ~ T t- ~ ' I i -ti es r a yPy 's AA-► f oe A4 I /4LTE2~NTE- SFPTvG INDUSTRY, T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN NDUSTRY, 1/fo6e Z DIVISION 7969 LABOR AND PERCOLATION TESTS (115) AQ-0/ MADP.O.ISON, WI BOX 53707 .~~HUMAN RELATIONS 3707 ~ c7 P5 J'I (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION:-gy`p p Q TOWN H P/h4dfd+~'Ff~°rt+ : LOT NO.: BL K. NO.: BDI~Vl3Ig_O~N NAME-- S -7 /T1 1 N/Riles E (or) W hY44kk& J S COUNTY: TER'S/BUYER'S NAME: MAILING ADDRESS: V 11~/ 1WI CQb IJ(oB~Rc M ELLb 11646 /66-T,4. k DATES OBSERVATIONS MADE USE : PER TESTS: N. BEDRMS.: COMMER IAL DESCRIPTION: PROFI E DVSUHIF ONS O ATI q_? T Residence unyl(\ New ❑Replace I J~ p'Z .Z619 Z ~,~t o{~i'NCp~ SJ Sar_5 CaD~ - CNa-rrK RATING: S= Site suitable for system U= Site unsuitable for system - CON \J M~ . ~ ~ IN G~ ~ P❑U RE: SY-STEM-I N~•FILL HOaLDING TANK: RECj~MME ( Tonal) jJU RI S E1U ®S U S ~Z If Percolation Tests are NOT required DESI N RATE: If any portion of the tested area is in the r. L~~S Floodplain, indicate Floodplain elevation under s. ILHR 83.09(5) (b), indicate: PROFILE DESCRIPTIONS art" HARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH MnEELEV-ATION DEPTH TO GROUNDWATER INCHES C OBSERVED EST. HIGHEST TO B DROCK IF OBSER ED (SEE ABBRV.ON BACK.) -t-5 ~ L 8 e r~N cs . 1\Jo q' 1 «•r5 i S $2>J5 l3 Kim B-Z (I.bO /03.62 ►Jon)E ? 1.~6 9q"BeNirws 4,4 Se"c<_5.6a B 3 83 99.9 nla a 3 /KA&wSI L Sq' .~~Nth~ 3~"g ~N M s B- A' 9?4L-r5 .OV 9 ~s.16 ~1 o N > l U D15 46" &_y_ 8e.,, csf G ~e B- 9.6-7 9926 9.0 9'9U:rS 7-I Be,~ S, L 34~$e~, MS~G~ S2''8a v~S~G e B- PERCOLATION TESTS EL t'~\ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES 00, NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH P. ( Q0 of1~ 101.7-0 3 y >Z > Z .6D 3 ~7 >Z >Z <3 P_ Z ID P- P_ ~(A-T ID A'S" P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. r_~urtA~ 1~- P!~ SCE UC`T To SYSTEM ELEVATION 1-7 TLI L 16T j 7_ T 7-s ! - I K141 I I c / ! d, ~t fix: ~ ~ - - - I I f T I I 80 4_ r _ _4__-r- i j I I -3:0 _i _ - - - - - - - - - I- - ~ 7---E J , JSI ('Y_ I J I o!6 A- l y:? A- SF. LdT Cue, 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proced s and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NA'My (print): TESTS WERE COMPLETED ON: I~1~r~~a Ja-I~soN ~a,~so~ S~vEy1.~41 Nc Zv /94Z ADDPESS: CERTIFICATION UMBER: PHONE NU 8ER(optional): CST SIG URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - WMconsin Department of lndustry, SOIL AND SITE EVALUATION REPORT Page of 3 labor and Human Relations °rdely t} eikfi"gs in accord with ILHR 83.05, Wis. Adm. Code COUNTY .5r C Rol' K Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference pant (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/ Rti C O GOVT. LOT $,6~' 1/4 .1/C 1/4,S7 T 2-j N,R 19 E (a (o PROPERTY OWNER':S MAILING ADDRESS LOT = K i SUBD. NAME OR CSM f1 I oy(o 100 1,(-. ALWL . 3 BLOC CsM 4j',?0& P2_ Uo/. 7. P -'VS 7 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY QVILLAGE Q N NEAREST ROAD ROBERTS WtS. SY07-3 (-1" 332-9 W1+R1eCV /07.9, ( rjl& Construction Use (vj"Residential / Number of bedrooms 3 Addition to existing building ( Replacement [ ( Public or commercial describe Code derived dally flow y5o gpd Recommended design loading rate bed, 9MW ' trench, gpdtft2 sG a' Absorption area r airedGV3 bed, (t2 3 trench, ft2 Maximum design loading fate bed, trench eq n9 9P~ , 9Pde Recommended infiltration surface elevation(s) SEE- pd... 3 ft (as referred to site plan benchmark) Additional design / site considerations 2c5 TlP6a ~r^ Fs 51 o P~ w/ i7Ro p 3 D x ~t'S T R f3 0 j'iaJ 5cs s f E= rEk Patent materiel F Cmrt E r f-t Flood plain elevation, If applicable A--1tl-- it S - suitable for system CONY ONAL MOUND N-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TAW U = Unsuitable for stem 219 ❑ u ❑ S IdU 0-s- ❑ u 1,0 CA 04-0 u ❑ S E,CfSSi SIoP~ SOIL DESCRIPTION REPORT GKL~SS/vim SIopE Boring # Horizon Depth Dominant Color Mottles Texture Structure Gon:sislencs Bou-claly Roots GPD/t3 in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed It ich A o- /oyR Y/I 21 AN Slit 4.% VfR cs .1,%% 1 . S .(9 C3 8-23 to yR 2.M^, ~p,e w►-r= R ~s i'F • S •G Ground CS Z3 - 33 7• s y R 51( s o, /V►, s d R. • -7 •9 1W 1 elev. it C2- 33.70 /0 yR S/F S O c ,s .Q .1 Deem to uniting Th s test Sit APPR ED. Remarks: Boring A y :511 2- 4-j She 1141, Vf 2 As% . S • 6 3 Q, /-15 /0 VR VI 57i 1 z 510 /Hn-P R C-5 I -F -5 cs (f . S . 6 (3-z Is - i1 7. S y p. 51 s I .2 :5b& elev. rid C 1- g TS VR 5/4 S 01", 5 • 7 IL 61~m to ~a Remarks: c•~ T Name:-Please Print O t3eRT Zl L13 R i 14 Tr- Phone: ? 15 - 3 PG _ a I gs rasa: Co 5 s C~' tz l L RL? H 006^3 wl S • sl/0/4. ),J00- 'I -13 cS rM 8L Date: CST Number: t r,oTt - To BEST- fACi I -rATE' 6W. 4-W 's RLO, . PQZFeR&ZC-VS nR 16-i a^L.. 5011 -teST AIPE'A ~ S~ Pf;"pop't- aF zo'y Z ~y CST '3y gy whs Too h1' 6-f 3 cc~ov r.u l~~tuF QE00i RED A Li Fr - p om V AGE IN ~o v r F ftD v Se . ~-L. r' S ~u ¢w Sd r to S T ~2 L4 (11 A- c c0,4 on--tk- F1001f D/~?~ti,~ ~'•v i PROPEl~i1f OWN C3 • ~ ~ ~ SOIL DESCRIPTION REPORT Pape ?'"a PARCILI X I CS Vol. q 6, 2-q S-7 M 8 0& Z co t" 3 Depth Py ina ntColor Motess Texture Structure Consistence Bmsxby Roots GPD Boring # I•lorfzon In. Munsel t1u. Sz Cont Color Gr. Sz. Sh. Bed TWnch Li ' R y t s. z.,,.,, Shk ~UPR AS t3 y- is i0 Y R y y - Sd .2, 2, , 6kit fmf ~ CS ...5 Groud . C s IS-30 1.5 VF, 514 S 0, C• • s d Jc Cs • ~ • 8 ~Q CS ' ? elev. tL C 0 •50 7.5, yR SIP L A&A, d DOID S s O,c -7 C O 'fO V9 61 §Mng I bee P; Remarks: Boring # EE i Ground elev. Depth lo IBM Remarks: Boring #i 13 Ground elev . K ID M*v tecbr Remarks: 8oting # GmW elev. K Depth lo kniling Y' bcw +I i i Remarks: ~r. .Icon oeon.o 0%cnm i 10 a f31 ~I, ~1 / T33 ~~.80~ Zp / r e6o > 2.0 °70 slope "0 0 3 13 cHerQy ' T, T314 4t Z SvGC~e5TEl7 TIPEwt,(,. ~ SET LAY avT S lf& • $fEEL P~' pE ~ 1~ u~rro ~ SG ' gD.zs' 9,P•rvE ff7C* 3 , 1 StAkeD OOT 1 hf-oMES Tc- I I i 1 oet~A,e T. evhrro,J ioo, p r- - - - - - - - es r i /lev 's gLA, I AATEPkIATE' SEPrl'c AIPCA~ INDUSTRY, rxCr'UK I lily SUIL t3UKINUS AND SAFETY & BUILDINGS ` CABOR AND P.O. BOX 7960 PERCOLATION TESTS (115) /0-0/ DIVISION HUMAN RELATIONS c/ .ly5'7 (ILHR 83.09(1) & Chapter 145) MADISON , WI ~O'u. EOA N: SECT ON- TOWNSH►P AA {pp,{{{.y; LOT NO.: BLK. NO.: BWVVIISION NAME_.-_ E V4 -7 /TI N/Ria E (or) W IJJ4IC A) ~ MA LING ADDRESS: Ka Ix -k08iTk- M ELLv io46 ~Da-rN Ko S V✓~ 4o Z3 USE NO. BEDRMS : COMMER AL DESCRIPTION: DATES OBSERVATIONS MADE Residence New ❑Replace PR F N A 1 ESTS: l J7 9Z i Zo 9z Sot~t k A46 ~d' D~ - C~°T RATING: S- Site suitable for system U- Site unsuitable for system ON ENTIONAL: MOUND: IN_ -GROUNDPRESSURE: S S EM-IN-FILLHOLDING TANK: REC MMENDED SYSTEM:( Tonal) „firs' IS DU -IS DU 4JS DU PqS DU DS RTU D SIGN RATE:` Ederrc.. ation Tests are NOT required LHR 83.09 (5)(b), indicate: CL If any portion of the tested area is in the ~lS Floodplain, indicate Floodplain elevation: C_ Rowti~-~ PROFILE DESCRIPTIONS BORING TOTAL ar y NUMBER DEPTHJI>X ELEVATION PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH OBSERVED E . I HET TO B DROCK IF OBSER ED (SEE ABBRV. ON BACK) Y o. e- .67 )1112.13, ~o .67 to"~eN Ms 6e Zo` $ae,,, ;Ir jCS -G L B-z )06 X63.11 roN~ 9,~ 4 ~QN cS~G e u B- 3 .eN 99.E o N ~ 3 "BUTS /L"&WS1 L. 4III wn1~ 3 9 Z11 Q1 B. .bv 9$.16 ^JaNL' > IU,D~ 9$l1'iS I eti ,L rs ~Q~ ) N 49.6-7 81_1c $ eN 9 9.70 o>j L q 47 9 ~$t [`rs Z I "BeN S, L 34''$e~, rhS~G~ SY'8Q U ~5~4 e B- E(..t 1. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUMBER AFTER SWELLING INTERVAL-MIN. RI D t RI 02 P R RAPER INCH ES P. 1 v o,1 loz.2o 3 > > Z > Z < P. Z ,D 3 >7 >2 ; Z ~3 P- 0 3 >Z >2 P_ P AT 1p AT ~C_ P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent {a P~ Ste' CT T6 _,af+and slope, U..._._z - SYSTEM ELEVATION 9650 i CCoAeTfe~ _ z Too. 7 I ~-l - .1 -_-__.__1__ j I -r j r J- P. A - 3 r 1 , i I /I F f'1 I , _ ....I_ _ f t i © ifs V -j- IL I _ -0--I i SE LaT Cat. I the undersigned, hereby certify that -the soli-tests repprted on this form wore made by me in accord with the proced s and methods specified in the Wisconsin Administrative Code, and that the data fecprded and,the location of the tests are corretK to the'best:of my knowledge and belief, 11 MI) { NA print j - TESTS WERE COMPLETED ON: +~eJQ a lfJS-6w . AD ES d I7JS0 JU ~V v "I /^1 C Z(- / 7 Z O~ &U' 9~ : O CERTIFICATION NU BER: PHONE NU BER(optional): 1 • , . , CST SIG URE: I i DISTRIBUTION: Original and one copy to, Local Authority, Property Ovgnerand Soil e T st9f . DILHR-SBD-6395 (R. 10/83) - OVER I 4~y 4~ j ~ MAY 05 194 08:03 1ST FEDERAL BANK 715+386+1853 TO: 6126394575 ® 3 • i w AIJAM81+` 3t ►~►8 36 gcrt* sLJPVEY MAP IOEATI I Located in the E1/4 of the NE1/4 of Section 7, ,T29N, P - Warren, Tov~n o Warren, St. Croix'30anty, Wiscon.Sin. Surveye Jt.j ' zind ov;-ed by: Reber4 Moll(:) 1046 100th A Roberts, Wi. 5402 P PR ttOR7H NE OF THE ATT F, D N SE 1/4 - NE 114 _ IR AYE-W r + - N 89' 48 ` 19"E 653.73'- N _ _.5 69' a2 ' 10~°~,i bl' gg' 4w?' i0"w 60 40C ROADWAY EASEMENT FRO ' 3Q5.61 la0 347'5~' C S M. IN VOL. G, PA49 1690 Z11 ~ (gUII.QING SETBAC K l D TEND 1" iron pipe fnd.' w 4~ a q ~14~a 4 0 1"X24" iron pip _ 0o weighing 1. 68 Lt r. -6- Uo Lin. Ft. set. U. ~1 I ~aIn Fence N~ a to a o aev Section. 0 monument (Berz senw N J _ M w N caps N 452,693 5,F.yl0.59'7 Aj M I 'N 6IL INC' UDING PA.-1~l. 'N 13a * Lu '.aa ' s s "w s' 30556' x 436 ,?.2 7 EYC!!JDING {lr•').-W. 1 Bearir•v referenced to 1 1 w Q sectic s line, aseurraed C► c^ N90°0.'110"W also O F-1 Z house . ly e• :,x'ded ~ as iVL)O" 00'00"W . CL-• r. N SWALE v) y.( 1 WUL! g~ G 1V,= With t1~_.~~ +~LL~)I ~ ~ h s D. w ,t.dding land t4 Lot 1 and cretting Lot 3 septic: ` U.I ' area \ u.~ . 1; 1 I area. 1 N9 000, 0 'W 305.84' 11 338.28' N 90°,JO'00"W V,y / c c r . IV 90' QG?' 0 "bft 1511.921'`°- 3 6,r" . 63 Sec. 990.'38 !PREVIOUSLY RCGO Ell T29N, 1$W AS 3990.63'I L BAST- WEST 1/4 SECTION LINE EIi4 GOY. ~t1N11l0l/► t Se C . 7 UNPL TTED LANDS N _ P~ARVEY o;,lr: JOH~I8 d SCALE IN Fa-T i"- 20d HUDSON Wig Ioo o zoo - aoo { 1 MNt+M~r7 ORAFTEO IV JWG ~N~ pus 99l-1745 i~N L Vol. 9 Pa.v 2457 I I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER. MAILING ADDRESS PROPERTY ADDRESS I 0 7 4", ~ to 4V (location of septic system) Please obtain from the Planning Dept. CITY/STATE (Z~~~ts U-T-V7. S(-( Oa3 PROPERTY LOCATIONS 1/4, h)~ 1/4, Section T Z9 N-R V9 W TOWN OF W a I t r, ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 3 CERTIFIED SURVEY MAP 8 49 , VOLUME , PAGE Z 457, LOT NiTMBER_ 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 year expiration date. SIGNED: IceAw DATE: t St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 1a 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 G f kc-, (V\ e l~© Location of- property__S;~l/4 /Vt'1/4, Section -7 T 29 N-R W Township W °~~~Q^ Mailing address o 6 a0 f-- ' (2. 1b,-+ O Address of site 0 -1 l4vC_ W S~IU 2~ Subdivision name Lot no. Other homes on property? yesNo Previous owner of property $a tv a k' NV\ c Total size of parcel d c cr~S Date parcel-was created Are all corners and lot lines identifiable? ~L Yes No Is this property being developed for (spec house)? Yes _X_No Volume 9 and. Page Number Z 7 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 & 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. yf46k,-gL , 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 County Register of deeds as Document No. JA AA Signaturejof plicant Co-applicant Date of Signature Date of Signature ~ I ,ice w•s,~c~~ v,~ ~'~1{ OFFICE f 7 1 REGISTER'S E i o"CO,41 ST C rd __._t ~ r e r t ' ' L4_4 _ ; . _ Re fc(Record JUN 19 1992 M jI conveys and warrarts ro 3r of 10 : 45 I i - i Rcg)ster of Oteds ' i the following described real estate it :ounty - - State of Wisconsin. I Tax Parrel No I A parcel of lard locate.i e c t i o n T R iq'.y i..ren, ..eln7 +nor described as i u l lows; ' o-, ^t; 'ie` ;tr^ve ~ lp in `fol. 9 Pale =457 r~~co^:~d in the Register of -)c,e_is Office ounty, i I j I. i I Thisnot _ .m steadproCerry ~(is) lis not) 1 Exception !o ~^Jarrant:es. Dated thrs _ _ .-:•{+'C'~'1 % r "L. day °t L iSEAL; - .1SEAL1 $EAc; _1aG~s~IL~___~ /tom! SEAL) ! L L~ .1e l THENTICAi'ION ACKNOWLEDGMENT r- I~ STATE OF vV!SCONS!N ?^'X County aer sonal v came be ore me th s_ _ 9th day of authent!catedths_ day -of . _ . 19 _ a2_ theabovenamed - - l _o and t c i le ~I ii iL^• ^.Gshin. and rife - II I TITLE MEMBER STATE BAR OF ^,"SCONSIN ~ I ill -ot t •^cwn ?p be the person ° -.-._Nho exscute.:'tie I authorized y § 7_6 )6 Wis Stall) a,, n .nst,„ment and acknowirdge the same I~ THi W7TnL~.tEr.'.'.~S DR 4C rFJ l3r t IJJP j/ Janes O'Connell ~ - N c~. b~;c St1 Croix c:)~rty Wes T. natures may be 3~ ^.en hr ated Or aGKnOh'edyeC BJ!n Mr " r 55;pn s [;e-arent (I} not. state ex p!rdl:On are not rece55arv ril 2 93 - - - - - S82 vTF u21 WARRANTY pEEJ ;A-E °AA JF W~s'ONS N rleco Tox FO-S PO 3~-.x'0208. Greer bay W1543070208 .