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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNERr /A V &IIY4 z 47-I -Ti /AA/r ~
ADDRESS Cry -Z,~ 4
SUBDIVISION / CSM#~~ »y I/ ivru~cr~_T~~r ~izlt LOT
SECTION /J/C T ! Z-:- N-R W, Town of z/uaro,1
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVE THING WITHIN 100 FEET OF SYSTEM
~QoOoS~/~ LdjilVcw Y ~i~lo.crll~D , .
g7000
~/fG SLPT/G TiI.LK
~ GJ~TN C =
~ . G~WouT juSOEc7 c.N
. 1~r,vrs A7-f j o or-
0 A C' To l v ti
rl -T Pf c 04
- - - may'
INDICATE NORTH ARROW
,r
Al, RoArller'r vE~' Provide setback and elevation information on reverse of this -form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: Tic QN Ar S. w_ N9 `~o~//~ `
ALTERNATE BM:,~g~J L<,=v 9/c7SS t
I
SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION
Manufacturer: "i Es Q Liquid Capacity: ,7oyo (2,f-z.
Setback from: Well HQU4M N X17_5 Other
Pump: Manufacturer AJA Model# AJA Size A/A
Float seperation AIA Gallons/cycle: AJ A
Alarm Location )V A
SOIL ABSORPTION SYSTEM
Width: Length 7 S Number of trenches
Distance & Direction to nearest prop. line: ~5uT,4 3a
Setback from: well: o House ?3r Other
ELEVATIONS
Building Sewer ST Inlet: ?0.?. c~ST outlet 90.?. ~3`
PC inlet A IA PC bottom ICJ A Pump Of f A) A
Header/Manifold , 0/. G Bottom of system
Existing Grade Final grade 9 a5~
DATE OF INSTALLATION: 14;3
PLUMBER ON JOB: LICENSE NUMBER:
INSPECTOR:
3/93:jt
F
~vrandHum'an Relations , ~~1II~~TT 1.2 9.19 NAW M SW?EMC.t.h. County:
~QSC~fa9ar+ artrr+eM~JM}t]Str •
Labor and Hu
Safety and Buildings Division INSPECTION REPORT ST_ CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
193451
Permit Holder's Name: El City ❑ Village ❑xTown of: State Plan ID No.:
FM ev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
cal 0 20-2866-00-000
TANK INFORMATION ELEVATION DATA A9300112
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 4,3 3
Dosing
Aeration Bldg. Sewer
-~<1
5,9 90 V"
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 7 fir} r. -
Verit
TANK TO P/ L WELL BLDG. A
irIto ntake ROAD Dt Inlet
Air
Septic ' ' l NA Dt Bottom
Dosing NA Header / Man. A
F, i ~ J ic:7
Aeration NA Dist. Pipe
Holding Bot. System y
PUMP/ SIPHON INFORMATION Final Grade r t% ry
Manufacturer Demand
Model Number GPM
TDH Lift Friction Syestem TDH Ft
oss
Forcemain Length Dia. FFii Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS J DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER
7'e=~ 3 r CHAMB Moe Number:
System:,-/ << " ` ;L 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 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:1{~UDSON.21.29.19.,NE,NE,IOT #16 & 17, c.t.h. a
b } V 4 I
L.
\ 4 F 1~ C~~ r C .
i,
Plan revision required? ❑ Yes ❑ No ?
Use other side for additional information.
17 1 T i3l L
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than /g3 'TS/
8% x 11 inches in size. ❑ Check 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.
PROPERTY OWNER / PROPERTY LOCATION
T (re,91A V~`•tlTct =5 AJi % V Y., S T P1/, N, R f E or(5j)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CISTATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
h`aDso.~/ 0/ (1 1 ( x VE.vTU,ffs NDa i~t Qif~
II. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ VILLLL4GE ~ NEAREST ROAD
Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - FIGEL AX u R )
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
20 Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 4 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 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 43 ~ ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. f.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
/,/o / 41~1sSq SQ jc:r- 9'04 dU Feet 5OS. -?SFeet
VII. TANK CAPACITY Site
INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper.
New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank ~v c90 a / L1J c A H,
Lift Pump Tank/Siphon 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 nature: S ps) MP/MPRSW No.: Business Phone Number:
AWW &(; _f V;v c, z ~~~~5 3395 Sit 3~G-- ~ Srsd
Plumber's Address (Street, City, State, Zip Code):
i5 1, i Sow 4Ji 5'~v/
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Samar jtary Permit Fee (Incluhayeroun water a e Issued Issuin Age Signat Sta ps)
*Approved ❑ Owner Given Initial
f1X'( O
'
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8, Buildings Division, Owner, Plumber
i Ai
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 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.
Ili. 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 DII-HR.
Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tan<s; 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 so!I absorption system if
required by the county; E) soil test data on a 115 form; and F) ail 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 cche- Aed through there surcharges are used for rrunitoring groundwater, grourrtt-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
b
` .r'~, a f•
+ i O -r' a
r.
Highway 35
C \ -vr1 m rO pooa~
r:. (Z _ - 1 C to .
4 *000
`Ah C.
Sant
d` ~,11 st s 4
= ~~.y? l pa Broken Arrow Rd
a ~
W $j ,1! C7'.•p 0 ~
SouhCarmrhaelRd 0
. I
Carm.Khacl Rd. IL_ O
N y 1 80
.1..,:'r:CiOn n
Ea, Ta•a La.
Glee" r- Br~r Hcwn p. t `f
Ar o Wes N . W ti ^ 3z pF~ ~a pli uny I
4 Nath V,ew Dr. yyF i .f' N Q~ Y!~ ' g~
ONeiNRd. C~tq~ R u IF l
- Cou lly v r Do-«m Rd. Age F a ~9 c+ Sherman
N _ Wit` r 3 Rd Sher n La L
uos~
Q-D o Las$~e La. ' 3*
D A
rNJ~ Da Ad,
1(
Yrew Rd Z
W aNbDr . W O r I\
.2. 1
McDonald
r. `'PA La. r
^.yw X16 Y \
a~ - 0
P ao ~d~ Ro ti o e 0
a`- OQt+ g ° rlw Of. ~ V- C c `S ' p '9° Q
~a- 1'"110 (a Aldrola Aldro0r. C y y
c tJ w y ~
C!D 7-
Iw too
o r ~
Pda ~ ~ Scott Rd. Scott M41
c 8a4k
Rd. - Scott Hd
KNry .
Z to
Kit La. La Barge Rd. 2
1
am
Tr.
f --1, Taney La.
Rd. = a
= r
x Hutton
b n Hdl g
Dr. Cu. ~ ~ .
P~
r '
0 Sumac Tr.
Ann,
~aJC ae 3 Q Q i
~g Qa Qa ~ ~ ~
•
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.
Owner of property !5T G1~\~ V~t~~VTZ6
Location of property LV 1/4 Ne- 1/4, Section T Z1 N-R W
Township
Flailing address '11 4 5J~u~ 1? b~~J
Address of site Subdivision name Fkz~ Lot no. tL. 1-
Other homes on property? yes ✓ No
Previous owner of property
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)? Yes V/--"HO
Volume and Page Number as recorded. with the Register
of Deeds.
114CLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARItA ITY DEED which includes a DOCUMENT NUIWER, dOLUHE AND PAGE,
11URBER & THE SEAL OF THE ItEGISTCR 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. , and that I (we) presently
oo:n 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.
'f _-4~d!j
Signature o ap¢l c nt Co-applicant
r
S-
Date of Signature Date of Signature
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER-
ADDRESS FIRE NUMBER
CITY/STATE ~N~~~d-~ ZIP
PROPERTY LOCATION : NL
1/4, 1/4, SECTION-, T?2_N-R_J'2_W
TOWN OF , St. Croix'County,
SUBDIVISION -T-cCzoIX 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 date.
SIGNED: `
DATE : 1,9 1,93
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
tabor a'!Rd Human 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 ST CRO IX
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
ero i Ven Ar e GOVT. LOT n/ j' 1/4 1/4,SZI T Lq N,R 19 E (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
+2 6s l~dos's r;r 4~ ~K
; v
a c~ >o c~ of l6- l1 Is-rckd',XV
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY (]VIL'L/AGE (MOWN NEAREST ROAD „ n
il/ 5 7 (!iZ) 5r~,~-~790 r~tl~Sa C T N u f A
New Construction Use [AA Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [4 Public or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpolft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/112
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 c NVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem kS OU IBS ❑U OS OU 27 S OU 4S OU OS U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiench
Ground 44,99 1 my R 4 14 'PS I 0.8
elev.
t.
q c§
Depth to
limiting
f Ctor
> 2
Remarks:-r'SPSdtL N.cs BEEN S~fQf~P~s Away
Boring #
tqyik 4L
-7-'a /e +13 - Ms rGc rk I C I 6.7 0.8
Ground _
elev. $ S-2-f i6yle4 1 10.8
9as.'79 ft.
Depth to
limiting
factor
> 33
Remarks:. dAS $CdN S--k/PpEA AWAY
CST Name:-Please Print Phone: Qgb
/,~,aeYcy ,,Jou Soil
Address: P O X Oil N v ~So pi kJ I S 46 16,
Signature: Date: ` / 9 3 CST Number:34
PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.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
13-11 lOY4413 A- 94 Yll c 0.7 OX
Ground g 7-7 7.SyR4 4 5 n1 C 0.7 OIK
-7 1
9 6%ft. $ 7-53 /p 4L3 - S M r►► 1 0.7 O.$
Depth to 3-I11 /6 ot s/4 S O m D~ ':fY.g
limiting
f for
Remarks: -7b Sd)~ IJdS &E4Aj S4,el PPR-A .
Boring #
r ri:»:v<<< -14 /DYe 413 V1 f_f_ 1 C 14P
< Q 14.3 /a 3 I - L 2 a L K M C I
K.v.,....:. $ h-42. 0 4 3 5,L 2 c g p 10A o
round
G
elev.
Depth to
limiting
factor
Remarks: Sd mo SA "A V?i (L 6\(L--k 6POL),-J1,.
Boring #
0-1b /oy 3 i=,LL 5 (3, rn . 90 m l N ni
14,
Y S q - .5 z a 1 b k m .4 o.S
$ ~S 2g /DYA 4-3 SL 1, m, cll.to K rr►C 1 10,S 164
Ground
ele
S~ b K n,~,' I p.S 0.~
196? ~sv.9 ft. 2Fs- /D 3A-Z- q
Depth to
limiting
fBctor
9Z
Remarks: <-,5M& 6020UIV1
Boring #
yr{
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
4
z
~ w
a ~1
~ Q
V - CIO
CIO
~ M
Qi- ►
V ► ~ ~l t
Y~ ~ ~ e a
.Oo cA ~ ~ a ~ k~
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i
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`N N
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT' Page I of
tabor arx Human 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 ST CRO 1 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
Cr i L )P- LOT NE 1/4 A/E 1/4,S2/ T 29 N,R 19 E (or) W
PROPERTY OWNER':S.MAILING ADDRESS LOT # BLOCK # SUBD. NAME /OR CSM #
ofX /6-11 STC*6 V ,d--, 0k SS /qA0ST1t14L PK
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD „ n A
(biz) ss~s~ ,z 790 ailsa e -r N 'u t A
N New Construction Use [g Residential/ Number of bedrooms [ J Addition to existing building
[ ]Replacement [K Public or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable It
S = Suitable for system C NVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem , S❑ U 0.S U S❑ U ~I S❑ U 4 S ❑ U ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
Ground ~A -991 / to 4 Z4 FS / O•
elev.
q~ ft.
Depth to
limiting
f ctor
Remarks: -rOPSdtL /4,4S >BEEN SrrtR1•PP4t& ALZ AY
Boring #
Z` $ _ o 4L3 MSS n~f 0 :61
Ground
elev. $ S-2-/ i6ye4 10X
905:71 ft.
Depth to
limiting
factor
33
Remarks: -rop-sol< dAs $CLN S-*1Pflj!-A ALjAy.
CST Name:-Please Print 14WEV \OU S64 Phone: 7~ 3g~• Qg6
Address: P o x 9 1 1J(,DSarV LN/i S 46 16
3~
Signature: /\f Date: ! ' CST Number:
PROPERTY,OWNER SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture GrStructureSh
Sz Consistence Ebu Roots Bed TMnch
in. Munsell Qu. Sz. Cont. Color . . . Bed ra
fig. 3
(1 0-7 0-T
Ground Ig Z-Z-7 7.S se 4/4 5 /K Yh C 0.7 0-16'
9 elev.
6ft. $ 7.S3 4 3 S rr► O.7 O.$
Depth to 3-/ I l /4 R I s/4 J S Q r►1 0. ':O.g
limiting
f ctor
~ .25
Remarks: ToPS6~~- 14AS 94EcN ST~er Pr~~Q .
Borin 9# . LL Alp
A- ci) F ~ 4 /DYE 4 r~, . ~
~`<< Q ►4 -3 /0 3 1 L 2 ask ~r-~. C I .S
36- 4 JbYR 4/3'
Ground
8 qZ- /Oyr~4~3 5 M M elev. O.$
90 ft.
Depth to
limiting
factor
' "R •i-7 i
Remarks: SdkC- ~.dNb ~-'1(L dJL-'r2 ~it~~•
Boring #
.s z b I bK m,' .4 o.~
MA 4-13 as
Ground
ele
~s9 ft. 28 /0 3 S C. a b l< p.S 0.L
9c~3
Depth to / /DYE 3 5 rn
limiting
factor
Remarks: S11Y►1G ~A~fl ~(.C, O~/~~2 Gr2oUn1.~
Boring #
`f
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SSD-8330(R.05/92)
r 1,
Q
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3
Labor and Human Relations
Division of Safety a 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 ST Cto I k
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
. 54. &.6 i X Ile.,-2 Y4e GOVT. LOT NE 1/4 1/4,SZ/ T Zq N,R /q E (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAM`E/OR CSM #
/6-1l s-rckal YTCASS /N0s30t►4L PK
CITY, STATE ZIP CODE d PHONE NUMBER [:]CITY ❑VILLAGE MOWN NEAREST ROAD n
A
WA) 5Y97 -69-V i S (bit) - o U CTiJ'u"f
M New Construction Use [0$ Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [)Q Public or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 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 C VENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem X S ❑ U L e s ❑ U as ❑ U RIS ❑ U S❑ U ❑ S W. i
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Mnclary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdl
0.7 101
Ground 8, ~A-1%9 / 16YR414 FS rat 1 O.7 O.$
elev.
9~5.3~ft.
Depth to
limiting
f ctor
Remarks: -r6PS641- /JdS ace^. STglopts Aw~ax
Boring #
} Z $ o 4 3 44 f, 0 ~'h C J 0. '7 10-Y
Ground 17- SZ /D 4 3 MS44t r,
elev. $ S-Z-/ 16W4 (0 IN, J 0.7
O.g
9aij-71 ft.
Depth to
limiting
factor
33
Remarks: `TO /BAS $C EN S-*1PP wAY. »
CST Name: Please Print /~~YEy \Qµ ~N Phone:
Address: Po. .p 9/ t fJv ~o r~► f S 4O 7 6
Signature: DCX Date: ! / Q CSTNumber:,.w4
PROPERTYOWNER SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Twich
3
$ 10-11 6 4 3 5 (3. yh, cm r'41 1 0.7 oX
Ground g Z-7-7 7.Sy,e4 4 5 n1 rL, C 0.7 PIK-
elev.
9d,.36ft. 7-53 /0 4 3 r►1 I 1 O.7 0.8'
Depth to $ 3-I Il /6yot N/4 :s 0, 9/) ph 16-T
limiting
f for
7 .2S
Remarks: `r0PSd)e- I. A& 64EEN S4'e, PP6-A .
Boring #
:>m: F 0- 4 /dY'+e 413 V, r_
(3, Ai~ C#1 AIP: r, C 14 111" 14 -30 IPA, / abK M-P C
a-4 0 1e4 3 5~ 2 qb fn -Fl C o q :off
Ground
elev. B q 2- /oyR 4 f 3 5 Q 90191 ft.
rn
Depth to
limiting
factor
X% .17
L
Remarks: SdME 'SAIA i'1U- dya-0, CiROLJWD.
Boring #
}44.i tv-}••. •.}..:.v F; 0-1b JOY P,43 f=j LL 5 0 M l I N P N{~
5 q 16-I1~ .s z o L 1 bK mC)' C 1 .4 -!S
- L 1, m, a4K C S o b
$ 1-5- 29 10YA 4-13 5
Ground
elev. 28- l0 3 S L 1 a b K n~~; p .S O.t;
903 ft.
Depth to
limiting
cto(2
> 9
Remarks: 'Ssr►1G -!5,Aju& FIU, Wek UOO&Ijk
Boring #
w;. rtik
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
h
V
2
(V
C4
I
Q
l~ _ N
a.
Z
Yid ~ ~ C 4
i 7 4
.i
vo
j J
1
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- 1
17~
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14
4, Y 3 w
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9
i
i
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7y G~ ~ J ~p. N 41
10 p N
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3
• Labor sand Human 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 S, Cleo !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. 0,X0 -/yu".5 -'Po
APPLICANT INFORMATION-PLEASE PRINT, ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
,,VIA&K ,4T_& emeteff N E 1/4 p( E 1/4,S Z I T 19 N,R E (or W
PROPERTY OWNER':S MAILING ADDRESS LO # BLOCK # SUBD. NAME OR CSM # ,Q
593 SYC,RplA V1P,,-t,~k('s /i-J&0S I A~R.K
CITY STATE ZIP CODE PHONE NUMBER ❑CITY FIVILLAGE OWN NEAREST ROAD
o~.v w , SY~> A ( ) U A%so Sc>Fvr~a9r~P ~~P.
New Construction Use [ ] Residential / Number of bedrooms [ J Addition to existing building
j J Replacement Public or commercial describe 0Pz*tj r 15- i c--ro,?Y
Code derived dally flow gpd Recommended design loading rate bed, gpd/ft23,X trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 - Maximum design loading rate o.? bed, gpd/ft2 AZ trench, gpd/ft2
Recommended infiltration surface elevation(s) g / / . 6 Q ft (as referred to site plan benrhrtt ki-, F
Additional design / site considerations
Parent material Flood plain elevation, if applicable It
S = Suitable for system CO VENTIONAL Fr~OU.ND IN- ROUND PRESSURE T- RADE SYSTEM IN FILL HOLDING ~T K
U=Unsuitable fors stem I S❑ U ❑ U I S❑ U S ❑ U S❑ U ❑ S ~9 U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twich
-5 lLaY+2 / L 2 s b c rh r p,5 b
x:$
inn:;: _/o /ov 3 S~ sbk r>7 r O /-Z O.S Q
Ground Q- 4 /OYrK Q- _ 5 d rh C / 0.1 O.~
elev. 3 s rat 1 O? 0 ~S
9~~.$3 ft.
Depth to
limiting
factor
> ~2 S
Remarks:
Boring #
y z z L S b c 0,
6-9 „
h
a $ 'rh rte I c
_53 ` ivv►~ 3 4 5 i a.~ 0.8
$ '53-/4 / $ O.-7 a g
Ground
elev.
9/s'17 ft.
Depth to
limiting
factor
> i6.80
Remarks:
CST Name:-Please Print 11~~~~y, ~Sd Phone: 4o n
Address: dd'AS67v W;
Signature: Date: 3 _ R CST NumberR04
,PROPER;KONNER Mai SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twch
3: o-r~'' oy 3 z - S4- n, r Z 0 S
j 5 JO 3 - + m l C I _l A
Ground L7 /OYk4 r~ r+~ ~.1 ~(3
elev.
jti' ft.
Depth to
limiting
factor
7 / 7,G7
Remarks:
Boring #
~C Yy► it .L~. S
4 lag, Zt
re" $f w-29 Apr 3 2- 1 sb'v- a Q.9 d.5
/OYK 3 ntn ri,t i OAS
Ground ,
elev. l7 10Y 0e 4 3 0
9io.d ft.
Depth to
limiting
>l°r~
Remarks:
Boring # C
ss, ra 00 ni c Ground - S 01
/m 4 ,7 Q
elev.
le) ye
l .ii ft.
9
Depth to
limiting
> 7•SiS
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
NW Ldr CoR
to _ - 7a' ~ - rD'
$_Z
4 ~r
ql
l%Z
z
)0 ~ ~ Q- I ~,dLL j ='3Ol
-7d'
i
i