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HomeMy WebLinkAbout004-1032-90-100 Nf STC - 104 c' AS BUILT SANITARY SYSTEM REPORT 10, QL06 c f AG+r T OWNER t ✓Dcr i~ r,~` C'R0 w' ti ADDRESS 10 3Q~ £ A SUBDIVISION / CSM# A12 LOT # oy SECTION-2-~-T--?-LN-R~ W, Town of ST. CROIX COUNTY, WISCONSIN 'Y PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM pw _ BA .r l E~7 .C>7 Q~'trv.~ l 0 7 ~I / 0 ~U I' 9U TNnTrATR%NORTH~JARROW Provide setback and elevation inform tion on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. G' BENCHMARK: ALTERNATE BM: ,D ~i c~ of J % ,l~ 7 d SEPTIC TANK / PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: z~Jl~r~Qrk~ U r~~~~I Liquid Capacity: Sao c~ Setback from: We11N_)C)- House 'Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other l' ELEVATIONS Building Sewer ST Inlet: ST outlet _ 3~ N PC inlet PC bottom Pump Off g3,11 Y.2 Header/Manifold c 2.b y Bottom of system gL lqS 3 Ss Existing Grade a Final grade DATE OF INSTALLATION: - / PLUMBER ON JOB: ~L LICENSE NUMBER: INSPECTOR:~ 3/93:jt • Labor and nd ~ Human i Relations ~try28.15. 221~ItWX9$A5GE SNYEM County: Safety and Buildings Division INSPECTION REPORT T. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GI=NERAL INFORMATION 193415 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: qC. PRIME LADY re v.: Insp. BM Elev.: BM Descr ption: Parcel Tax No.: ~l/l~. ✓ ~_~tJp 004-1032-90-000 TANK INFORMATION ELEVATION DATA A9300075 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. j~P Septic..` ttS fv Benchmark o?./Q l4~•? Dosipeg-- C/ Aeration Bldg. Sewer Holding St/W Inlet G- ~ SD TANK SETBACK INFORMATION St/kK Outlet Vent TANK TO P/ L WELL BLDG. A ir Ito ntake ROAD Air Septic / NA Dosin NA n 9 g3,Ca~ o.d~• Aeration NA Dist. Pipe ~3,~ _10o,/0.93 Holding Bot. System /°,J 8/' PUMP/ SIPHON INFORMATION Final Grade 9,9s-~ ga Man cturer Demand poi T,Ix P 3, ,ayl' Model Number GPM Df-S r X,23 9 C) / TDH Lift Friction Syste TDH Ft oss Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS ufacturer: SYSTEM TO /L BLDG WELL LAKE /STREAM LEACHING SETBACK INFORMATION Type O CHAMBER ~,yr % OR UNIT Mode Nu er. System: ~rC 7 - DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length S7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CADY 14.28.15.221A,SW,SW,WILSON RD. 0:19c~/~-~"-'° m Plan reel I.'K',e`clulred. ❑ Yes ff-N--o Use other side for additional information. 1:5 11F SBD-6710 (R 05/91) Date Inspector's Signatur Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 7D SANITARY PERMIT APPLICATION • ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY - . e. ST CROIX STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El 9~ Yon `8% x 11 inches in size. c ec if rewo 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 JULIE SPEER SW t/4 SW t/4, S 1 T 25, N, R 15 E (or X@ PROPERTY OWNER'S MAILING ADDRESS LOT # N/A BL C~ Route 3 RIVER FALLS CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER RIVER FALLS, WI 154022 715 425-6884 N/A II. TYPE OF BUILDING: (Check one) 1:1 State Owned O VILLLLAGE : CADY NEAREST ROAD • WILSON ROAD ❑ Public 01 or 2 Fam. Dwel11ng-# of bedrooms ? PA EL NU BER( III. BUILDING USE: (If building type is public, check all that apply) 004-1032-90 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 94.8 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) 92.6 ELEVATION 300 7%01 600 600 .5 N/A 91.0 Feet 93.1 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 strutted Se tic Tank or Holding Tank MIDWESTERN PRECA T _Iua~ . I-000 -L Lift Pump Tank/Si hon Chamber VIII. 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 Stamp MP/MPRSW No.: Business Phone Number: BENNIE HELGESON 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY m ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No zo:) Approved ❑ Owner Given Initial Surcharge Fee) _Q dverse D rmination 7 A X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety 1£ Buildings Division, Owner, Plumber INSTRUCTIONS f. A sanitary, permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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; close volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be•retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5/A5, G~P_ Owner ~ of Property ~ ~ r_' - 2 ~ mC2 :.Location.of Property NE• Section T a N-R J~ W Township l" i Mailing Address 6" A~ Address of Site 3 /a IV r .Subdivision Name Lot Number Previous Owner-of Property 0 Total, Size- of Rarcel . .Date Parcel was'Created / Are all corners and lot lines identifiable? ` Yes ' No .Is this property being developed for resale (spec house) ? Yes l~ No Volume• and Page Number ._as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantv Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In~addition, a certified survey, if available, would be helpful so. as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION (We) cvLtiby that att statements on this bonm ahe tAue to the best oS a (oun) knowtedg e; that Y (we) uxr ( cute) the. owner (.s) o j the pro pent y de s cA i,b ed in this .i.nbo,anati,on bonm, by vi tue ob a waAAanty deed neconded in the Obb.iee ob the County Regi6ten ob Deeds as Document No. ; and that I (We) pnesentty own the pnopo4 ed site ban the a ew g e. d is poa a ys em (on I (we) have obtained an easement, to nun with. the above descxi.bed pnopaty, bon the constnucti.on ob said ayatem, and the same has been duty neconded in the Obs.ice ob the County Regi6ten ob Deeds, as Document No. 5/~97~3 1 SIGNAT OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) LILz ,..DATE SIGNED DATE SIGNED i Stock No.'11063 497770 I . Von 1003PAGE 533 QWWooiddn-I3w* rs Anodetion 1992 THIS SPACE RESERVED FOR RECORDING DATA SATISFACTION OF REAL ESTATE MORTGAGE - BY LENDER i S OFFICE The undersigned Lender certifies that the following is fully paid and satisfied: i 's-1. ORGY CO., WI KEMER C SPEER AND JULIE C SPEER, I Fir-'d for Fecord Mortgage executed by APR 2 1 1993 AS JOINT TENANTS WITH RIGHT OF SURVIVORSHIP 2:40 P.M to Lender and recorded in the office of the Register of Deeds 449744 LQ Doc Of ST. CROI X W ~ri, as No. 451867 , 846 in (Vol.) 852 of(R rds jfW 226-220 RETURN TO: N ) n(page) , %TaV reel. Mtat dSscribbdTHW belpSw T QUARTER OF SECTION 14, TOWN 28 NORTH, RANGE 15 WEST ALSO SOUTH HALF OF SOUTHWEST QUARTER, SECTION 14, TOWN 28 NORTH, RANGE 15 WEST, EXCEPT 9 ACRES MORE OR LESS, CONVEYED TO ASUNCION WILLSON, A WOMAN, AND MORE SPECIFICALLY DESCRIBED AS THE NORTH 18 RODS OF SW 1/4 OF SW 1/4 OF SECTION 14, TOWN 28 NORTH, RANGE 15 WEST. ❑ If checked here, description continues or appears on attached sheet. STATE OF WISCONSIN Dated April 6, 1993 County of PIERCE T E FIRST NATIONAL BANK OF R-WEa FALLS NA OF ENDER This instrument was acknowledged before me on April 6, 1993 Ti- I ff24' N VICE PRESIDENT by JEFFREY M MCCARDLE & PAUL E SCHWEBACH * JEF. M MCCARDL (Na- of person(s)) - , as SENIOR VICE PRESIDENT 8,VICE PRESIDENT Attes (type of auftnty e:g.•'officer, tn,stee, etc. d any) THE FIRST, T~ NK' 0k RIVER FALLS Title VICE PRESIDENT 7, t Of ~ (Name of. ally on bow of whom kftl4tneilt was executed) N `.1 * PAUL E SCHWEBACH v.. ? * t This instrument was drafted by: t; C ST.. ROIX C RUPPERT, LOAN ASSISTANT FNB-RIVER FALLS Notary Public County, Wis. My Commission (Exoiro. ( (TYPE OR PRINT) *Type or print name signed above. . DOCUMENT NO. STA 3AR OF WISCONSIN FORM 1 - 1988 , 5 SPACR RESERV[D VOR R[CORDING DATA WARRANTY DEED r I 449743 L Svc! 846PAGE no OFFICE I This Peed, made between ----G---e-nevi•------------eve Mi--l--l-er 1 a si ng a person ST. iSTER' CRDIX S CO., WI , - _ _ Recd for Record - . ~ I~ ----------I Grantor JUL 18 1989 and-------------- ---Kemer._C_--Speer.--and..Julie-_C__-Speeri------ as------------- at 8:30 M I; ---j.o_iit.tenan.ts, with-.r.i_gh-t_.of s.urvi_vo.rshi_p, - - - - Grantee, Reg WwofDe d!-."', Witnesseth, That the said Grantor, for a valuable consideration------ RETURN j a7_t_.41~o~.x conveys to Grantee the following described real estate in (~+~t County, State of Wisconsin: jj Northeast Quarter of Southwest Quarter of Section 14, Town 28, Range 15 West. Also, Tax Parcel No: i ji South Half of Southwest Quarter, Section 14, Town 28 North, Range 15 West, except 9 acres more or less, conveyed to Asuncion Willson, a woman, and more specifically described as the North 18 rods of SWI of SW4 of Section 14, Town j 28 North of Range 15 West. TRMSFEB 0-0 I i L This __._.__..i.S__..not homestead property. (is) (is not) j Together with all and singular the hereditaments and appurtenances thereunto belonging; Genevieve Mill-er--__-----"--_-----__--._.__ And - - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except ! I and will warrant and defend the same. j 89 ne ' Dated this - - - -1-5 day of -----~u-- 19-- I I ~ j (SEAL) 41-'r/--PCP--------- - - - (SEAL) - - - - - - - - - - - - - - - - - - - I Genevieve Miller i - (SEAL) (SEAL) j * I I AUTHENTICATION ACKNOWLEDGMENT I' Signature(s) ___of_Gene)[le-ve_.M_iller______________••-.-- STATE OF WISCONSIN Ss. i --------------------------------------County. I ?t ed this . 1.5 ..day of....... June 19__89 Personally came before me this ................day of ------------------------------P 19-------. the above named * Robert R,-- Gavi-c TITLE: MEMBER STATE BAR OF WISCONSIN (If not, j authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. jj THIS INSTRUMENT WAS DRAFTED BY ROBERT R. GAVIC ; ----------Attorney "at--mow * Spring--Va11ey,_.WI._547b7..... Notary Public County, Wis. i (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration ~I are not necessary.) II date- 19 ) If *Names of persons signing in any capacity should be typed or printed below their signatures. ` I I I STATE WISCONSIN FORM No. Stock No. 13001 ST C- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/WiFF,-R 12 ( S ROUTE/BOX NUMBER 310 3071 ~y Fire NumbergJ6 • I CITY/STATE [N l ~s0A) Z IP D~ PROPERTY LOCATION: Id Z, SUS SectionN , T ;'ff N, R /5'__W, TOW ~771VP of St. Croix County, Subdivision , Lot number _ Improper use and maintenance.of your septic system could result in its premature failure to handle wastes.;~ Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three-year expiration. 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off.kce within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2235) or 715-425-8363 Sign, date and return to above address., Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of _ Labor and Human Relations Division of Safety R Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY l/ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but -)T e not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELLD. # dimensioned, north arrow, and location and distance to nearest road. Can y- - / 3- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 71-x, ~ .eC t-- GOVT. LOT V, LO 1/4 ~,t_.~1/4,S / T ~j N,R I S E (or)~ PROPE TY OWNER'i MAILING ADD E LOT # BLOCK # SUBD. NAM OR CSM # A/ C ;;STATE ZIP CODE PHONE NUMBER CITY J:IVILLAG WN NEA EST OAD OL Z' 0'e Ir [ ] New Construction Use [ 14Residential / Number of bedrooms - [ KAddibon to existing building [y'feplacement [ ] Public or commercial describe Code derived daily flow 30 gpd Recommended design loading rate ~I bed, gpd/ft2 ~trench, gpd/ft2 Absorption area required Z5 Q bed, ft2 P6 trench, ft2 Maximum design loading rate ` bed, gpd/ft2 ~trench, gpd/ft2 Recommended infiltration surface elevation(s) 1.2. (oa-A _ 51 c) ft (as referred to site plan benchmark) Additional design / site considerations - y v .5- Trerc~ c s Parent material L ce / 7, l~ Flood plain elevation, if applicable A JA ft S = Suitable for system CCOONYMIONAL MOU IN-GR D PRESSURE FFAT-DEO SYSTEM IN F HOLDING T U=Unsuitable fors m" I S O U B-1 - 0 U ❑ U U O S ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends O- )o 0 S ~..J J S r LIE'* Ground 3 -!P l o ce~ C( 5-- . .2 (4 elev. q6-.16 tt Depth to, ew~ limiting Ce factor Remarks: 66~- l S k y hQS a F U S / t) Boring # MA C u) b t~ Ground elev. 0 t. y 6' v~ 3 Depth to / ? 5 a u t s6 n~ (a Z . Y . r limiting v s ~ facto s Remarks: CST Name Please Print 41 5" t Phone• -7 f 'a n -t 42 Address: l' r J Y Signature:- Date: CST Number: ` a3 Ctiyc. PROPERTYOWNER_`CJ Glib. +oc~.~!' t 8O16 DESCRIPTION REPORT page of PARCEL LD. , Boring # Horizon 0. - aM;Color; + 5 Mottles Texture Structure Consistenoe Bound3y Roots GPDift in. 'fVlt n§ell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed n~ -6~k kv,- In LA) Ground 3 ~1-149, J F , S elev. S , r ft. Ig 8ik . Depth to b` ye 15;t t 64,k w4 e s' limiting - 7-1 fac or tJt) EF _ ` 5 Remarks: Boring # Ground elev. - -fti: Depth to 61-1 limiting., Y., factor Remarks: 4w Boring # Ground elev. ft. Depth to, limiting factor Remarks:; Boring Ground elev. ft. Depth to Limiting factor Remarks: IIL r• C-5 T: I, 30 A&A Fie,, 0A lv-e-e 91,1 . 3, ' (j.rouncQ EIeJ• . ./~I e I . U 9a•7 •a3 10 d I rey,A\c5 sa~ Qct e-,e a- l ow"~ Ek r c d . ~c«I~ l` yL' J l I~ 'I T~tc. ,~I/~~K 1 i ~ p~5«P d gzc~ er A L" h e 5 ~ ~ ; , ~y ti 0, v l'.h~5 ' ~tA) c ~ i; / Yom(°p c. C-C3 cf @ ~ -QL J ~ i I R1I 4 'at :1 ~ C~Pte 7..'• moo. F►~.~~t o X5,3 s M~cIM(.trY~ IJefY~l~ b~ ~XCa~.~a.~ic~h ~rcw~ E•w-~~ lhai C~-ra~.Q.~, C~.~~~1 40~._.-~-. -~'v,c~-e~,~ ,l`/I~v~~w►c,_w~ e~ ~xcctiuc~~~o'~, ')fo~.n ~Yis~v~a~ C*'rajt I ion @PJL RDYMSG DISPLAY = REPT131 cady ST. CROIX COUNTY ZONING PAGE 1 05/17/93 09:45 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/18/93 AREA: JT Activity: A9300075 5/18/93 Type: CONV93 Status: PENDING Constr: Address: CADY 14.28.15.221A,SW,SW,WILSON RD. Parcel: 004-1032-90-000 Occ: Use: Description: 193415 Applicant: SPEER, KEMER C & JULIE C Phone: Owner: SPEER, KEMER C & JULIE C Phone: Contractor: HELGESON, BENNIE Phone: Inspection Request Information..... Requestor: Ben Helgeson 00 Phone: Req Time: 1:45 Comments: /0 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION Wisc ansin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Lyjsiornd Human Relations Divsion of Safety & Buildings in accord with ILHR 83.05 Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 5-F e ot limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELI.D. # e n71 dimensioned, north arrow, and location and distance to nearest road. Cott -10 -go APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ; - GOVT. LOT S u) 1/4 5WI14,S ! " T N,R I S- E (oroV PROPE TY OWNER' :S MAILING ADD E LOT # BLOCK # SUBD. of NA~4OR CSM # lyk C STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAG WN NT EST OAD [ ] New Construction Use [ rrResidential / Number of bedrooms .2 [ Addition to existing building P-]'replacement [ ] Public or commercial describe Code derived daily flow 300 gpd Recommended design loading rate _bed, gpd/ft2 . S trench, gpd/ft2 Absorption area required 15 D bed, 11:2 Od trench, ft2 Maximum design loading rate bed, gpd/ft2 ~trench, gpd/ft2 Recommended infiltration surface elevation(s) 1.2. ~v - __3LD_ft (as referred to site plan benchmark) Additional design / site considerations v.,9- 7y-R -6.c s Parent material & c e v / 7, l r' Flood plain elevation, if applicable -T JA ft S = Suitable for system cONy~ZONAL MOU IN•GR D PRESSURE AT- DE SYSTEM IN F HOLDING TAW' U = Unsuitable fors stem Q'S El U 11 U ❑ U S ❑ U ❑ S ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench W t 0-10 MO. 7 Ground 3 -!P I o "r S LL) - V , S- elev. e ft. & LL O `1 K. C y SS I, AJ J~ Depth to fly limiting CevK factor Remarks: 60' -I -:i6 3 ~l h~~ ~a~cQ s o U ~ S l U R xlo Boring # O t b rn~h Cud a~F s kv.}.•. vi\tiist p Ground 3 0 v h S S CL) u elev. - y l D . S cft. 610-g t 57 Depth to uc- 10 ? 5 C 0, s~ -rj limiting facto Remarks: CST Name:-Please Print Phone' Address: A) -76 V c? ~TLL) la rI K .P -i S Y _Sb 26-7 ignature: Date: a 3 CST Number: ~y y c PROPERTYOWNER (Jcdie SOIL DESCRIPTION REPORT Page - of PARCELI.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 57 Ground CJLL,) J~ S 6 elev. Depth to ;S 5 5` -3 L 6 o, S . fa limiting fac or ~v Remarks: Boring # ....slit: \:.:•n Ground elev. ft Depth to limiting factor Remarks: Boring # x>: dvki~s.ss•.n.sv Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) t ~uJri e F k -e so c le r Flees ~qq .llk, oo. ©o ~~~b► ,L a / r FJe, 1 1~ ~ 6t,c- O( Elev 94.3 ' 5 qa,7 33 11 11 i i ~ Al~~e I reY~ch<5 SQQ'~1~ ~b" 17Q Q~ ! c uuez - r Pe vac Y- t-N~cur ss 'Y -t 1