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HomeMy WebLinkAbout032-1007-70-110 -0 0 00 O~ v) ke) c x c N h m ~ `C 6 O c Z ~ m C° U. III Q i i Q, w E = °o Z `m m M ~ a m U 0 O Z ° v U O 0) 2 d c ° fA e" O N Z c 'a m N N~ N O CD N • Fri 2 ~ .c O ° Q O Q Z m z N z N N m Y `4 a 'wo b c m co 04 u) 00 °v D o a a m N° Q ° F F H ° V C) Z N N a ~ - 0 0 0 0 a Z O O (o tL CL (L E C0 M N O N a) G) m J U O O N ZV! } CO N MO O O O (n co E N d O LO V) 0) • LO 'O d Q N C ~ d p CY) rrii r. O O A'. -0 E LO (D 0) m a) O ° , 7 O c o ^ 0 c: v o °p rn °o 1~ _ d C N r N 2) o 42 0 N r O t' 7 0 N L .0., -0 y ~ W ° - ~ O O t- ~Trl ~ N M O O a 0) O E ~ U • y' CY) O Cl) O U) p z w Z to O ~ I V ~ ~N r~ m a # a L: 0) a w • c a d 0) a A U a O m v .r a 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT # SECTION . 3_T y-?/ N-R~a W, Town of~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ' d scr/~ i ,,INDICATE NORTH ARROW Provide setback and elevation information on reverse of this -form. Provide 2 dimensions to center of septic tank manhole cover. w BENCHMARK: /0 61 6 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING.-TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location I :SOIL ABSORPTION SYSTEM Width: ,11?_ Length Number of trenFhes Distance & Direction to nearest prop. line: u~ Setback from: well:- House_,,, Other ELEVATIONS Building Sewer ST Inlet. /h/,~l ST outlet /0.17 PC inlet PC bottom Pump Off Header/Manifold %;2, Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: - LICENSE NUMBER: INSPECTOR: 3/93:jt LG0W10*zrtfi0MERfflN, 03.31.19 fft j:L0 St E .STVM) County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar wit Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PiTAIRMS .K k9lFuNT sp. BM Elev.: BM Descriptio Parcel Tax No.: 140, 60 A50, 66 032-Iuu7- TANK INFORMATION ELEVATION DATA 3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z(X~C/c Benchmark e"d 0') A • , /OS. 70 Dosi n Aeration Bldg. Sewer 3 ~/S Holdin St4k Inlet TANK SETBACK INFORMATION St/ J~f Outlet (o, p3/ /vz.y 10/?'' /0/.77I" TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet J~ Air Intake 7_77 7 Septic NA Dt Bottom Dosing-W-- NA Header. 9S T Irk 9Z,7 Aeration N Dist. Pipe „ 5 n cd a `r-- Holding,._- Bot. System PUMP/ SIPHON INFORMATION Final Grade Ma acturer Demand Id 3.30 Model Number GPM TDH Lift Friction ystem Ft Forcemain Length Dia. Fi Dist.Towell SOIL ABSORPTION SYSTEM BED /TRENCH Width i Length No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth DIMENSIONS ~o? DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ufacture : SETBACK INFORMATION Type O (',:r , Mo a Number: System: ~sa~ 37 60 z OR UNIT DISTRIBUTION SYSTEM Header / it Distribution Pipe(s) x Hoe S+ee-__ x Hole Spacing Vent To Air Intake Length _6L i 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/ xx Mulched Bed / jt%0C4rCenter Bed / T¢~ Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 03.31.19.47A-10 (55TH STREET) G Plan revision required? ❑ Yes Erit_O_ Use other side for additional information. - - SBD-6710(R 05/91) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH, h . SANITARY PERMIT NUMBER: II I i ~DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~.a...,,.e, STATE SAINT R P~MIT -Attach complete plans (to the county copy only) for the system, on paper not less than / [/j, do 8% x 11 inches in size. ❑ Cfiick 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. PROP TY OWNER PROPERTY LOCATION '/a '/a, S T , N, R (or '.11 C -!5 z PROPERTY NE 'S MAILING ADDRESS LOT # BLOCK # /,I- CITY STA E ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : r~ RA 4!1i6;ea4T1 ❑ Public " 1 or 2 Fam. Dwelling-# of bedrooms ~ RRW AX NUMBER 111. BUILDING USE: (If building type is public, check all that apply) 7^ TD^A0 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. X New 2. ❑ Replacement 3. ❑ Replacement of 4.E:1 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 M Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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 Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank S Lift Pump Tank/Si hon Chamber El E]_ F1 1 1:1 El VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for install! ' n of the onsite sewage system shown on the attached plans. Plumbe s Na a (Print): Plumb 's Si atur. (No Sta s) [M/MPRSW No.: Business Phone Number: 7 50 y 9 Plum 's ddre (S rest, City, State, Zip Code): i i' IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature ps) Surcharge Fee) ❑ Approved ❑ Owner Given Initial < Iv °~j 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 r 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. 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 aid/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, purnp/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, ".icense 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) 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) r I I I I 26- - I ~I I I i IT~~ I ' l - r - IIA C-A LL - - j I I i t II ~ ~ I I i I ' I ~ I I r i I ~I I I ~I I I ~ I ~ ~ ~ i j i I ~ I 1 , , i l II - - - I- - fi - - - - ~-f - - - - ~ -t--~-- -ill-----~--t- ~ - I I ~ i i 1 I I y i ~ I j i I ' ~ I I I I I I , I n I I -I ' II i I I I I 1€ I ~i I I I, I~ 1 i II I ~r I I I ~ I I ! l r - - - t-- -T I , 'I I j I I I ~ I I I I I - I I I I I I I A i I I 77- I r ,CrvS I• V~.`~I V11 O~ I. V~IL. i•~ t: .1. y /N III. Ab IMoIc 'Aao '1660 moss pipe MNh14 Veal CN • . Itwel d• , 80. 420 Above PIS C•H I/M `l~ • Ifs IU•1 O/N• Mal M0 , • ~ was =Fy~M.•H10 • 01•uq•11~ • hIC Too • i A~p•HI• ~ i•w•1~ II~• Pwlw•~•• Pipe YNw • +'t•rlh~ Twwh•1M! Al ~ bll~w 01 il~l~w pro gr&A-c ' .~1.,~•.~ eon iO1L FILL• OMTRIBUT101.1 PILL APPRO'IEG S•INT1tCTIC COVE iZ~OF hGGREG/11IE'-"' ^ ~'~MATEIZI^L OR 1*OF STItAM OR MARsi+ N,Ay ELEV. oF~FELT or~i-t'.,= AGGRCGATC. IN ~L OISTRI6UTI01j ►1'^F x'0 pC AT t,EAiT _ IWCHE3 SCt.Ow ORiG•I►JAI. ',AA.0c AQU AT LCAST&0 IWCHEL OUT 1.10 MORC THAN 42 IuCIi[5 dCLOW FINAL rw1k^OL '.ham M"IMUIl pEPfVi OF E)(CAVAT100 FROM 066WA1. r61Z v WIL4. BE ~ ~ IucHCs tVKJP1VM ©EPT11 OF' EACAV.ArjcN r'&O ^ QIGIIlAL GRAPE Wlt.t. 6C ~ INCHES alGuro: v. , LIGCU3C uUMOC1r. DATE: - /r K~> Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of LaPor and 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 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 PROPE OWNER: PROPERTY LOCATION GOVT. LOT 114\S - 1/4,S-__? T N,R (or&) PRO ERN NER':S MAILING ADDRESS LOT # BL0 K # SUBD. NAME OR CSM # Cl STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE ®f WN NEAREST ROAD _ (7/S- ) _ _ -]2 I J 7 -117 New Construction Use [X] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement ( ] Public or commercial describe Code derived daily flow r~n/1) gpd Recommended design loading rate 7 bed, gpd/ft2-=trench, gpd/ft2 Absorption area required bed, ft2 XS-D trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s)a~ f' ft (as referred to site plan benchmark) Additional design / site considerations Parent materialI jlej)~ elljr Flpod plain elevation, if applicable AP4 ft M S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S ®U [IS ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench V14 I -Z Ground elev. ~L~ ft. Depth to limifing factor Remarks: Boring # /10 ye Ground elev. ~klz ft. i IS, Depth to limiting factor > F60 Remarks: CST Name:-Please Print / Phone: C/ Address: _~2 Signature: Date: CST Number: ~-s~- I PROPERTYOWNER - ' SOIL DESCRIPTION REPORT Page,,;z of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundar GPD/ft Boring # Horizon in. Munsell au. Sz. nt Color Gr. Sz. Sh. y Roots Bed Trench v / , Fj I Ground - _ elev. ft. Depth to _ limiting factor Remarks: Boring # Ground elev. 54 ~ft N Depth to limiting factor Remarks: Boring # AVI Ground , elev. r 1 ~ wft. 97 '7' Depth to limiting factor y7 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: I i I y j I ~ I ~ I j f I I >7 sl ~ 1 _ - 1- I I I I- I -44 , I I I j ~ I I I i I I { I , li4~7 ~~~~IT /Z/ Y /I I I I - - - Zl- , Ij j I ~ 1 T -7- I I I I I ~ I I~ ~ I I I-' -r ' TT~- I I I I I i I I- I I I ' i 1 I_ I I I I I I ~ i j j I - - - - - - I I .I ~ ~ I I I ~ I ~ , I I ~ i I I - --I j j I j 1 j •j ` j 1' 1 ~ ~ i i 7-7 77 - ~ 1. t----- ~ r- j ~ Ir I ~--~-i I--I I----I j I ~ ;3yi i i i ~ 8' • I - C/3s; r - - - T I I I i ' - S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County aye OWNER/BUYER A ADDRESS i>- 3 U 575-a 5 V, FIRE NUMBER 3 X CITY/STATE_ _5 ®MLCdS ~7` l i / ZIP_ .syoa PROPERTY LOCATION: SECTION 3 T 3 J N-R 1`. _W TOWN OF_'S , 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 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/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 Co. Zoning officer within 30 days of the three year expiratio rX\date. C SIGNED: DATE St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and signed by he owner(s) of the ~ property being developed. Any inadequacies will only result in delays of the pormit 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. - 0247'~~73 Owner of property ~,qw tq M, -t6 rv~ • L, ~Oe, 6%4 Q.40 Location of, property S 1/4 S 0 1/4, Section T_I;, I N-R_ftW Township 6 0 t Pe--a 7- Mailing address --100 e,=AR 04 LW& A 1" Address of site ,.2 3,N x^ S?. .SoiYI.~~Psrr+ AA/ s'y0~2s' Subdivision name Lot no. 7 other homes on property? yeszt' _No Previous owner of property k Total size of parcel • AGE W ~ 7 lj/ Oo S `r, 0y S- j_ 12t.1 _?A20-,799 Date parcel -was created _ Nd V AN46 Q aSiz -A Are all corners and lot lines identifiable? =Yes No Is this property losing developed for (spec house)? Yes ✓No Volume V and.Page Number 33 as recorded with the Register of Deeds. ----------------------_•----------------------------i----------------- 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. 410 a ay , 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 s gnature of appli nt Co-a licant f. Date of Signature / to Signature j r 1 DOCUMENT NO. i WARRANTY DEED This sr.cc acuA•.ca roe 7~[c uacv NO DAT♦ i it STATE DAR OF WISCONSIN FORM 2-19821) 490324 rc~ 976nm 233 _ REGISTER' S 0-Fl--E - - - I ST Mix C0.1 W1 Steven G. Kuehn and Mary A. Kuehn, husband and wi f~,...-.... Ot,T 1992 as marital property-wi.th•,ri-ght~ .of..su.rv.i.v.arsh9p............. of 11:20 A.M c nve s a d tva ranta to Randa.l.. M.. R...... g. dn(1„ -j ndy..l,,,,•R.o.5b.u rg e` M0 Pius..an~ an. wi.fex..d5..~o.f.cat...Lena„ts of D*A { 11[TUIIN TO • • the following described real estate In St....CCOi.X............. county, State of Wisconsin:, O-U loo 9 Tax Parcel No:.... aC... l i II i i Part of Southwest Quarter of Southeast Quarter (SW 1/4 of SE 1/4) and art of p Southeast Quarter of 3outhxefst Quarter (6E 1/4 of SW 1/4) of Section Three (3), Township Thirl.y-One (31) North, Range Nineteen (19) West, describwd as follower Lot 4 of Certifiea Survey Map filed November 30, 1989, in YOlumO "B", page 2170. TOGETHER WITH and SUBJECT TO 60 toot private roadway as shown on said Certified Survey Nap. TOGETHER WITH 88 foot private rcadway as shown on said Certified Survey Map volume "8", page 21145, and Vulume "e", i Page 2156. S o is not This homestead property. FEB (is) (is not) Exception to warranties: Dated this ..................ly............_..._.._...._. day or .......October.............................................., 19....92. .....................................................................(SEAL) ......C~c...A~ .........(SEAL) . • Steven G. Kuehn .....................................................................(SEAL: ..--i~►:./ (SEAL) • • Mary. A• ..Kup-tits....................................... AUTHENTICATION ACHNOW LBDOMBNT Signature(s) . STATE OFMM14M Min-les to as. Washington county. authenticated this ........day cf 19...... Personally came before me this 19........day of stober 19....92 the above named Steven G : Kuehn .and_.MsICY..A....Kuehn husband--and wifex..a;.•mari-tdl ..praperty... _ - - TITLE:MEMBERSTATEBAROFWISCONSIN with rights-.gf••surX.fyar.Ship (If nok authorized by 1 706.06, Wis. Stats.) !,e me known to be the person ..5........ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ATTORNEY'S TITLE Of 8TI WAT®i - iTf11 TEA. W10 ~ C~ U Cd I.......... 4.,.... .=--•v-:----......r....J Notary Public ..........................................County,X*U MN (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration 19......... are not necessary.) date: ti ••-•••••TEiiflY6•KAIITfl$...... ) X wowar PUBUC • rurlESau► eNam.s of persons signing in am eapaeitr should be typed or printed below their sig>rturv. WASHINGTON COLON Ion s Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1- of t. ebor and 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 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 ROPE OWNER: PROPERTY LOCATION P _ GOVT. LOT 1/4 1/4,S~ T N,R ~(orNJ PRO E TY NER':S MAILING ADDRESS LOT # BLO K # SUED. NAME OR CSM # CI STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE [Y]T WN NEAREST ROAD - ( - New Construction Use [X] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow r~41 gpd Recommended design loading rate 7 bed, gpd1ft2-,-y-trench, gpd/ft2 Tc trench, ft2 Maximum design loading rate __,._bed, gpd1ft2 trench, gpd/ft2 Absorption area required RJR bed, ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent materials Flpod plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S ®U ❑S OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. Bed Trench 1A VY _-2 1 Y;K J, 5 Ground ?4 .14 elev. ft. 4' '7 Depth to limiting factor Remarks: Boring # Ground 17, Y~2 -24 _9"e 4 elev. ft. C_j Depth to 12~ , limiting y0 factor -2 Il~y Remarks: - N CST Name:-Please Print Phone: Address: COUNTY itu Signature: Date: CS u ` PROPERTYOWNER A~,y ,,Oq -[S SOIL DESCRIPTION REPORT Page of S' PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. nt Color Texture Gr. Sz. Sh. Consistence Botx~dary Roots Bed Trench / ,2 1/ Ground elev. eft. /5 Depth to _ _ limiting factor 71 Remarks: Boring # .~.,..'i~S J Ground elev. 2Z V Depth to 5- LY limiting factor Remarks: Boring # Ground el Depth to limiting factor _7 y7 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) I I I I I j 1 r , I I fi I=-~~2Sy~ ~ ~ I I I I 1 ~ 1 I I .j I I I ! 1 I ~ T ~ I 1_ ~ ~ ~ I I ~r I ~ i ( I ~ I I t I 12 I ! i ~ I I ? I I I I - fi - ~ -T- - - - I, - _ I - + I I ~ I ' ~ I t I I ; I I ' , I I I _ - - r , ~ • I, I I I ~ ! i I ~ i ~ I I ~ ' I ~ f I I ! , I ~ I ~ J__I I ~ I I I I I ~ --r-~ I i , , I I , IJ I i~ , 1 l~ - - - - I I i I - I- 47a.'' --r - - --r- 1 I I I I I , i I I t I ~ I ~ , I I -i ~ i i_ I - ~ ! ~ ; _ _ - _ _ _ _ _ _ ~ I - - -r - ~ ~ ~ ~ i I ~ ; I ----1 _~_--T' i.__.__.~__ i t i ~ ~ I I ~ ~I I i ~ I ~ ~ I ---~r _ j _T- i ~ ~ I i I i i ~ ~ I I - ~ ~ ~ I - f - - ~ - - i I j r i ~ I I 'i ~ ~ i I j i ~ ' : ~ I j ~ - - --Y------ I ' I i i I ~ i i i i 1 - i i ~ ~ ~ , I ' ~ ~ ~ ~ I I i I i I ~ ~ I I ~ i I i, I I _ ~ I - i i i i ~I ~ 1-- _ _ ~ - i ~ i i ~ ~ ~ I I 1- ~ 1 ; i I _ , _ ~ l - I I _ i f ~ ~ _ ~ _ - _.-1 i--_ ! 1 I ~ i I