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Parcel 020-1285-60-000 08/28/2007 11:49 AM
PAGE 1OF1
Alt. Parcel 21.29.19.1383 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - PATRICK, MITCHELL L & LYNN M
MITCHELL L & LYNN M PATRICK C - %ST CROIX CUSTOM FAB
%ST CROIX CUSTOM FAB
589 SCHOMMER DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 589 SCHOMMER DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.010 Plat: 2496-ST CROIX INDUSTRIAL PARK
SEC 21 T29N R19W PT N1/2 NE1/4 LOT 6 ST Block/Condo Bldg: LOT 06
CROIX INDUSTRIAL PK 2.01AC ST CROIX
CUSTOM FABRICATING ASSESSED BY DEPT OF Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
REV-MFG 21-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1025/627 QC
07/23/1997 1020/21 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/05/2007
Description Class Acres Land Improve Total State Reason
MANUFACTURING G3 2.010 0 0 0 NO
Totals for 2007:
General Property 2.010 0 0 0
Woodland 0.000 0 0
Totals for 2006:
General Property 2.010 55,400 389,100 444,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
v ,
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER~iPO/~( ~GtSTc~~vl / /~/S -
ADDRESS
/7~s/Jro.✓ SS'QJ6
SUBDIVISION / CSM# 'X Z4AZn~&55DarFe16--14 LOT #
SECTION . T-;)q N-R / W, Town of /4'J50A)
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
rl o.v/rrl ~R . ~FN c NNI ARr(- i '011
or Ar Aj E- l aT ~P.vtR
ELEV. 90e7.
lei S~ .~8~/~~ poste a ~~K~•v ~ ~
0kCA,AJo447-1:iv50Q,-r-F10,A fj.AJd Al i
At T-
ED
w- 41-7'
_7.~sOA.4no'v 0611
r&A-7-1V Aj VE
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover-
i r
BENCHMARK : l "S/~'p,~ ~QE LIT Al -,c-. !~f'DAK-er`/ ~oP.VE~ E46 V. lv Jr- 6 "
ALTERNATE BM: ~ti/SN / av/! ~~c ✓ 9/~ `/y
SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION
Manufacturer: &Jlelg ~ Liquid Capacity: iS4C- lorfc
C~fF'/CE ~/S~iNG
Setback from: Well ?,g,oo " Hau~e
~Y" sa' 6r ~9. oo "
Pump: Manufacturer A/A Mode l#A/4 Size A114
Float seperation A Gallons/cycle:
Alarm Location n/A
.SOIL ABSORPTION SYSTEM
Width: Length S/' Number of trenches
Distance & Direction to nearest prop. line: )1,)vfr14 lam"
OGf/CF ~ QC.I~tQ~,i)
Setback from: well : y , oo' House 96 Sv Ott y 5'o,ao
ELEVATIONS
Building Sewer 913-00* ST Inlet. 911,s y , ST outlet
PC inlet 1\14 PC bottom A/A Pump Off AIA
Header/Manifold y'D 5~~ Bottom of system 908. 9S
Existing Grade / SS_ Final grade 3S
DATE OF INSTALLATION:
PLUMBER ON JOB: LICENSE NUMBER:
INSPECTOR:
3/93:jt
L+ 0ATJ0Hprtbi>iW0NL QA.29.19 ( 90RE ~~'+~YSTEM County:
Laborland Human Relations INSPECTION REPORT
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar unit
Permit Holder's Name: ❑ City ❑ Village R Town of: State PI
UIAXSX)
T g scriptio . Parcel Tax No.:
e.2.0-1285-6e ee
TANK INFORMATION EL A ION DATA A9300189
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark Q 91 q 015 90
Dosing
Aeration Bldg. Sewer (-Ds j 06
Holding St / Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Ventto AirIntake ROAD Dt Inlet
Septic yl S r a y NA Dt Bottom
Dosing NA Header / Man. ~,g3 9Dq, q
,r
Aeration NA Dist. Pipe
Holding Bot. System 105 90 "r5
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Lriction System TDH Ft
Forcemain I I Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
DIMENSION 5 2
LEACHING Manu acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION TypeO tt. CHAMBER Moe Number:
System: 7/1E') 1/U OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length _~L Dia.W/' 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.) s
LOCATIONt';HUDSON.21.29.19 (SCHOMMER DRIVE) r
I ~ \ ra~ $ ro ~ rs~ 4
v y~ , ~
Plan revision required? ❑ Yes ❑ No 4/-
Use other side for additional information. 94 k
4 t'
4~
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
7 UILHR 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
❑
8% X 11 inches In size. eck if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPE TY OWNER PROPERTY LOCATION
v a•y+ /4 T/ c~.t/ A/,!57% AX6 S `o 71 T ?q, N, R /q E (oilg)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
~9 (I NA
CI , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME 99R CSM NUMBER
/>So.u Syo/ / " 3 -12e// ST ,PO/x V _C-iVTU/j4- t45 /,+L
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE O5 ON ~c nld~n'/E/T Q
XPublic ❑ 1 or 2 Fam. Dwelling-# of bedrooms - A TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) cr0
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 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. ❑ Reconnection of 5.E1 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 12. 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) ELEVATION
S9C7 931~. SS r• Feet 9/~?- <Feet
VII. TANK CAPACITY Site
in alions Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App
Tanks Tanks -1 F1 n F1
Septic Tank or Holdin Tank Tanks /6{ s- / G✓i~SE
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 Si ture. (No Sta MP/MPRSW No.: Business Phone Number:
®~4 MQiC 339 (Ws, _5 Z, - 'So
PI mber's Address (Street, City, State, Zip Code): /V '44
IX. COUNTY DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater ate Issued Issuing Age t s re (N tamps
0~ Surcharge Fee)
Approved E] Owner Given Initial a q
Adverse Determination
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 wilii 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.
It. 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.
Vlll. 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 incl:.ade the following: A) plot plan, draws 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 boxps; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal acrd 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 nun-,Ih , Jf
regulated practices which can effect groundwater.
The monies collected ilrtougli these surcharges arcs used for rrianitoring growidwater, ground-
water contamination investigations and establishment of standard
SBD-6398 (R.11/88)
STC - loo
This application form is to be com leted
the U ner s p In full and signed by
) of the property being developed. Any inadequacies
will only result in delays of t permit
issuance. Sh
d this
development be intended for resale byowner/contractor t
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate-deed-recording.
-
Owner of property 1 r 1 , 4-, KP,~ ~ 'Pok( i 6L_ -
Location of property& 1/4 __1/4f Section
Township aroSb
Hailing address
Address of site J C rnr,
Subdivision name 4,cro`1
Lot no.
Other homes on property?
yesrV'*~_No
Previous owner of property -Lb() HaS've,
Total size of parcel a OQLCS~es
Date parcel was created
Are all corners and lot lines identifiable?
I/Yes No
Is this property being developed for (spec house)? Yes _►✓No
volume and Page Number as recorded. with the Re iste
of Deeds . q r
INCLUDE WITH THIS APPLICATION THE FOLLOWING: -
A WARFU1ITY DEED which includes a DOCUMENT NU2iDER, VOLUME AND PAGE,
NUMBER & THE SEAL OF THE. REGISTkit 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( the property described in this information form, by virtue sof of
warranty deed recorded in the office of the county Register of
Deed; as Document No. _ a Vet ion
own the proposed site for the a ages disposalt ystem) err I e(we)
obtained an easement, to run the above described for
the construction of said system, and the same hasopbeen,duly
recorded in the office of county Register of deeds as Document
No.
signature of apcant
Co-applicant
Date of lgnature
Date of signature
_ _ , l
r.... .1p. - Iv
WARRANTY DEED
501802 rni 10-nu 21
This Deed, made between ....Sai.nl:..Gi;azx..Xantuxfas.............. ST. CROiX CO., W1
I a..MinnasRz..ztexal,..D.ar.tt~ezshi.R Recd for Record
.
Grantor, J U L 6 1993
'I and.....Sz ~xn~x.: ~uS.tAm: kabx.i.ca>ni.on,., .Zn~.. at 8:05 A,
M
W1t11 Grantee, IRegisterofiDeedg
esseth, That the said Grantor, for a valuable consideration......
conveys to Grantee the following described real estate in St_..Croix........... R[TURN TO
The First National Bank of H son
County, State of Wisconsin: 307 2nd St
Lot 6, St. Croix Industrial Park in the Town of Hudson, St. Croix
County, Wisconsin Tax Parcel No
i i
I
I
This is..no~....... homestead property.
Oa) (ia not)
Together with all and singular the hereditamenta and appurtenances thereunto belonging;
And.......Sainz..GXQIX..)IBTiCl3x~,S ..........................................."""f
warrants that the title Is good, indefeasible in fee simple and free and clear of encumbrances except
easements and restrictions of record
and will warrant and defend the same.
1 -e_
Dated this day of u-c.~ 19..53...
.....................................................................(SEAL) ::Sainn:,.Cxnix..V nt res. ....(SEAL)
• /L /G.'.7 .
I
(SEAL) ....G~~~~~•/~.~~ (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA
Hennepin..................County. as.
authenticated this ........day of 19...... Personally came before me this .....Z`.. day of
19..9 the above named
TITLE: MEMBER .C `rt.4-~
ER STATE BAR OF WISCONSIN 5o-c-cr >t Cvci
................t~...: - P.F........................
(If not .
authorized b
y § ?06.08, Wis. Stats.) to me known to be the p a son 5 who ecuted the
foregoing instrument d ckno 1 e the
THIS INSTRUMENT WAS DRAFTED BY
Notary Public county, ~
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date:
#Name$ of parsons eltalnR is any eapanity should b0 typed or printed below their elfin NOTARY PUBLIC-MINNESOTA
RAMSEY COUNTY
WARRANTY DEED STATE BAR OF WISCONS MY,oMMifsion ePVAEIE%,tk9 tai lank CO. Ina
FORM No. I -1984
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER I~~IfOQ,~~ ADDRESS S'39 FIRE NUMBER
CITY/STATE--" ZkC r-) ZIP_ "SH d
PROPERTY LOCATION: AIZ-_1/4,IVE 1/4, SECTION, T_.JLN-R.L_W
TOWN OF_~~~ , St. Croix County,
SUBDIVISION 0\k/~~`"' 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 a 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/Ile, 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 Co. Zoning officer within
30 days of the three year expiration dat .
SIGNED:
DATE:--
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
Wisod'►.in Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of
Labor and Human Relations
Division of Safety 8 Buildings 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 r ➢ x
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 Q
E (or) W
51''CA0I X lr C.f % A7 5 iCA T /d GOVT. LOT /q ~ 1/4 /J ~ 1/4,S'2/ T Z N,R 19
PROPERTY OWNER':S MAILING ADDRESS LO g BLOCK # SUBD. NAME OR C M #
41L iC
S-- Cho rx 1V us R I A L
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑V LAGE OWN NEAREST ROAD
( ) 14j"bS6 sJ CT N to
New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement IV Public or commercial describe
Code derived daily flow gpd Recommended design loading rate 0 bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0, 7 bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CO VENTIONAL MN~gUND IINyROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K
U= Unsuitable fors stem S ❑ U l31 S❑ U NG S❑ U WS ❑ U Ill S❑ U C3 S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
/ lQy~2 C 2 O. 0.S
V I 16Y4 4L-z- r -9 Z 01
Ground B i'>t~~ S tL. SID ri~'I r O•S° O,t;
elev.
90 6,1 `~ft. r .l 0$
0,
.6 1 - 137 i oyR, 4 4
Depth to
limiting
f Ctor
Remarks:
Boring #
0A 16.5'
.L7.146olAyp *14
Ground
elev.
IOA ft.
Depth to
limiting
7 fa tour
Remarks:
CST Name:-Please Print ilA~ Phone: _
r~.. 6 14 N5jovo ~ t1
Address:
Signature: !`I Date: Z p3 CST Number: 1~ 4
PROPERWOWNER S°sCRet,yC-OS-Icyh SOIL DESCRIPTION REPORT Page I of 3
PARCEL I.D. #
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 11 Ground
elev.
103,31 ft.
Depth to
limiting
factor
Remarks:
Boring #
AA 7.s y d - L. I s k r~,~r C . 4 0.s"
0.7 03
A9-/I-Z 16YKP iA
Ground
elev.
&A,- _7t ft.
Depth to
limiting
factor
/4,93
Remarks:
Boring #
A 4 ioYR 3 / -4
4/3
10 '7 0
Ground
elev.
103.79 ft.
Depth to
limiting
fa for
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
July 26, 1993 2226 Rose Street
La Crosse WI 54603
ZAPPA BROS EXCAVATING
715 6TH ST N
HUDSON WI 54016
RE: PLAN S93-40784 FEE RECEIVED: 240.00
ST CROIX CUSTOM FABRICATION
NE,NE,21,29,19W
TOWN OF HUDSON COUNTY OF ST CROIX
NON-PRESSURIZED IN-GROUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 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 ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on 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 inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
erard Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
cc: Leroy G. Jansky
SNn-was M. 01/91)
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of S
Labor and!-Wman Relations
Division of Safety & Buildings 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 CEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ~ W94 CE
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED-BY DATE
PROPERTY OWNER: PROPERTY LOCATION c
S ; ICAO f x cl 5 ; M ~d IC A-1 /Q. GOVT. LOT n(L t/a 1/4,S '2 / T Z N.R 7 E (w) W
PROPERTY OWNER':S MAILING ADDRESS LOT,# BLOCK # SUBD. NAME OR Cp #
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY EIV LAGS OWN NEAREST ROAD
~j C r N Ul.
New Construction Use[ J Residential / Number of bedrooms (J Addition to existing building
j J Replacement rVf Public or commercial describe
Code derived daily flow gpd Recommended design loading rate Q • bed, gpd/ft2 05S trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0, 7 bed, gpd/ft2 03 trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL M UND INS PRESSURE AT-GRADE SY TEM IN FILL HOLDING~~T NrfK
U = Unsuitable fors stem S E3 U S ❑ U S ❑ U WS ❑ U S 13 U El S PrU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Kfton,' in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
4/11 Al 2- o
Ground S <<. 5~~ 1 ~•S ~,6
r elev. - 13Z 'O 4 4
Depth to
limiting
Remarks:
Boring # 4
Z . -17 ? rY c; r~ l 0 S O.6
-7 10
Ground
elev.
/qA.IQ ft.
Depth to
limiting
' fact
Remarks:
CST Name:-Please Print Phone: "T, 0
:S s
Address:
Signature: Iyr Date: Z /9--? CST Number:
,•r •aY~\
•PROPERTYOWNER`- I-6ze,jxC-`'"N,"h FA4 SOIL DESCRIPTION REPORT Page -Z of 3
a
PARCe4I.D. #
Depth Dominant Color Mottles Texture Structure consistence cots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. BoWal/ Bed Trends
Ground
elev.
16339 ft.
Depth to
limiting
factor
i ie'63
'I
Remarks:
Boring #
7:3y~ 'z
Io 3~3 SI slag n,~r r- 1 S p,6
f) A
Ground
elev.
J ;lg ft.
Depth to
limiting
factor
y >I,g3
Remarks:
Boring # Z
K 4 2, ,&K
g 'z.1- 3 10YP,44 d M.OA a .7 d.
Ground
elev.
103.7 9 ft.
Depth to
limiting
> faqtor~
O
Remarks:
Boring #
}:y
Ground
elev.
ft.
Depth to +
limiting
factor
Remarks:
SRn-a33n(P N;/Q9~ 1
E J
C'o
z~ 0 ,
q
u cb - -
J ~ ~ ~ hi -C-S'~l ~ 1
~ ( Xj 1
111^^^
CIO
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Q
60
41 40
v
2
G
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FAQ r- 3
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CP
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