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HomeMy WebLinkAbout038-1169-10-000 C) H ,r p °v~ I a 4 0 ~ I I 0 N M ° ~ (D I to x ° I Y C .(D U Z = LL C m O O) 3 O l~ Q O ~n (D M z Z = ~°o I V0 o z a c J., V Z rn v I N N f0 O N O O O O O ° a C • 1V) d N L R t0 N N C> 0 N I V V 1~ C 'O ~ M= N N N 0 r z m z O N C, Zzo o o 3 LO c d o '0.3 ° Z E o N a> min E c a U) w U N va vi 3 ANN n. cn •N a 4)aaa CL c o rn > rn rn ~ Q aNi !n J U L O O M Lo O r O 0 ~rl co N 0 0 0 0 0 0 0 0 0 0 0 0 N O 0 E N N N N 2-1 0 O _ LO m co 0) M - m N O N 0o 0 Oo ~ C%l N w ta d a~<n o O C O IA C V o O ° c O O (5 co O N_ a_ O co ~ E O N C N V a 0 o Q1 O O O O N in N E OL R- N Q z-- N N N N W O V ` d oO OOi co moN M- O O a d N Oro y w v I- = N - 00 OD - N ~ 00 M f6 O p (n z E U • O r cn C O Z N Z~ 2 fn O I `m R ~ a ° ` IL Q v a m 0 U) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER V A e. C%4 S' J~ IL /V ` ADDRESS-0c SUBDIVISION / CSM# ro /e Q4 S' LOT I SECTION, 13 T N-R_ Town of TIct r /h A • ` e- ST. CROIX COUNTY, WISCONSIN PLAN VIEW. + SHOW EVERYTHING WITHIN 10(:4FEET OF SYSTEM 1 C- ~ 45 +P, / o INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: n / /I ALTERNATE BM: ell /K r~J ~3 * ~ • V r A,' ~ 4-- Cv° e N ~2 ev 7 A0 cjj 74 C, 4j-/ SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION Manufacturer: Liquid Capacity: J U U Setback from: Well ~Jr~ House 7 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location ':SOIL ABSORPTION SYSTEM Width: /0 Length 6 U Number of trenches i Distance & Direction to nearest prop. line: 25GL j- ft/- 3 (v Setback from: well:-4161a House Other Q ELEVATIONS Building Sewer ST Inlet.-- / QJ• 73 ST outlet Y,' 3 7 PC inlet PC bottom Pump Off Header/Manifold Bottom of system fth j5-~v Existing Grade 7 7, ~O Final grade IV- DATE OF INSTALLATION: PLUMBER ON JOB: ~j LICENSE NUMBER: 33 (1,4 INSPECTOR: 3/93:jt BENCHMARK: ALTERNATE BENCHMARK: BM: oA SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: 0 Liquid Capacity: I U U U i Setback from: Well House 7 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM 0 Width: lo2% Length 6 Number of trenches Distance & Direction to nearest prop. line: s Setback from: well: OVA House Other ELEVATIONS ~J Building Sewer ?3-14, ST Inlet: Q 11). 73 ST outlet Id' 3 7 PC inlet ttf; PC bottom Pump ~Off Header/Manifold ~~S 7 Bottom of system 7 - 6 Existing Grade 7 7, 4P Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 33 ?0 INSPECTOR: 3/93:jt L l;.,A A]0fI RIE.13.3W TE'SEWAGE RM County: Labor and Human Relations INSPECTION REPORT Safe*y and Buildings Division (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village X' Town of: State Plan I o.: CST BM Elev.: Insp. BM Elev.: , BM Description: Parcel Tax No.: B ~~5~~ -1169-10-nnn TANK INFORMATION LEVATION DATA A9300279 10 Y 3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 31 Dosing 3 9733' Aeration Bldg. Sewer , 16( St/ Inlet ~3~ Holding L TANK SETBACK INFORMATION St/* Outlet TANK TO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic S 17 NA Dt Bottom Dosing NA Headert~bo. 9 l~ 57 71 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION ra e' S 9 ~T Manu Demand Model Number GPM TDH Lift Friction S TDH Ft Loss ea Forcemain Length Dia Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length _ No. Of Trenches PIT o. Of Pits inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING anufacturer: INFORMATION Type O p&,o C'N'u, CHAMBER 7 Mode r. System: Q(, %,3 D OR UNIT DISTRIBUTION SYSTEM c Header / Maim04efd „ Distribution Pipe(s) x H~ x Hole Spacing Vent To Air Intake Length -LIL- Dia. Length (o 3 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems On Depth Over n rr Depth Over / /f v xx Depth Of xx xx Bed/ TftomFrCenter ~lD - d Bed /4sacu clges 3& Topsoil ❑ Yes ❑ No ❑ Yes ❑ No 46 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST PRAIRIE.13.31.18W (210TH AVENUE) t, _ Gt 117. Plan revision required? ❑ Yes No G Use other side for additional information. SBD-6710 (R 05/91) Date / Inspector's Signat a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I Ea70:1LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SA TARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8'/z x 11 inches in size. ch k f r ion to prev us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRO ERTY OWNER PROPERTY LOCATION J l'E. o",4., /7 c+ ~R g S' 5Z% '/4 S'GS'/4, S 13 T 3 f , N, R `C (Or) W PROPERTY O NER'S MAILING ADDRESS LOT # BLOCK # t)6 ~ 6( 5-K 6411.r I CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NA 7E OR CSM NUMBER di 0 y ")?a II. TYPE OF BUILDING: (Check one) CITY NEAP,.EST ROAD ❑ State Owned VILLAGE ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PARCEI AX N Ill. BUILDING USE: (If building type is public, check all that apply) //6/9 1 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. E New 2. ❑ Replacement 3.E] Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ 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. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9 J QEEL VATION 7p7 a / > $ Feet 6 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank Ooh u. G c. Lift Pump Tank/Si hon Chamber 1 El I El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plluum/jbber's Nam (Print): PI ber's Sign ture ( o Stam GGIP/MPR/S~W No.: Bu~ lness Phone Number: Plumber's Addr Street, City, State, Zip Code): _ Z C L{ ~j Y Lay Ja IX. C TY/DEPARTMENT USE ONLY ❑ Disapproved SaraI ary Permit Fee (includes Groundwater ate Issued Issuing Age Si No mps Surcharge Fee) ;k'Approved ❑ Owner Given Initial E, Adverse Det rmination X. ONDITIONS OF APP O AL/REAS N FORD SAPPROVAL: ` SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r 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: L Property owne!r's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. 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 marufacturer'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 tarks; 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) © i rls ' * -.Z9 z ward p NIt Q 2 bfl 'oe DEPARTMENT DUS OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS =NDUSTRYRY, c DIVISION LABOR AN P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 3707 (ILHR 83.09(1') & Chapter 145) LOCATION: SECTION: TOWN HIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 3w 1/ .5w'/ 13 /T 31N/ROBE (or) W 2 ` COUNTY: MAILING ADDRESS: 8 - Z 6S t. s a 2 USE ATES OBSERVATIONS MADE ~7'(Residence NO.BEDRMS.: COMMERCIAL DESCRIPTION: New PROFILE DESCRIPTIONS: PERCOLATION TESTS: p K Residence lace Z_ RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ms ❑U Z., ❑U ZU EIS C ®U e_e is X 6o-efo If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the CJ " under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- Z- S 'Y- 79- 89'' s. 0_/6 .&I, 10-23i, 607 .I., Z 3 - 3 Z B-3 `Lt 67. .5 B-?6`,Q ..S 6-85" g 8 (o 'l d 1311 , ,"o' L 3 `pen,);, Z 3 - 311 n'`~~p B- r o ' Q~ 8' Z I~ i Z Z - 3 7 SSG[ x °i'r ~11 ✓h~ . S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P- r T3 02 ~3 P- Z J_i /y P- y5 0 z~ P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. / SYSTEM ELEVATION 9a S I - 3✓ - 3 IY v' - p TN a j W , r F A f t ~I ~ to , - - 3 p p k ~ t 3 I , w 10 U 1 3r j , 'Al I, the undersigned, hereby ti t the soil t6s 're rted on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that edit rgc~eAf aid' a location of the tests are correct to the best of my knowledge and belief. NAME (print 1 TESTS WERE COMPLETED ON: W C107J In ADDRESS: CERTIFICATION NUMBER: PHON NUMBER(optional): CST SIGNATURE: DISTRIBUTION-. Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - r f INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Seperates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS dNDUSTRY, DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: IP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: -5w'/4 5'Lj V4 13 /T3/ N/Rie3E (or) W TOWNSH - COUNTY: MAILING ADDRESS: USE DOES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: /Residence /New ❑Replace RATING: S= Site suitable for system U=-Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ®S ❑U QS ❑U ❑S ®U ❑S ®U /-?x 66 ,;60 If Percolation Tests are NOT required DESIGN RATE: ~ If any portion of the tested area is in the under s. I L H R 83.09(5)(b), indicate: / Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- '96) 911.8 , 8 9 b-P`6/1 B-.o16•~~s,, a6 --.39~~ 5 R B- 941. 3 B- 8i 0-8,,0/j 8-1? ?`/ti.)d-~__JQ' 417s 3,9 'TS " 0101 '5 8~ 9v. 8 / a- y B- 8 ~ x-r- ryn - 8 c~s B- > o-/6 `.,G//, yJ/ aY_ ~a , YO -VT " 8b J / - S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH 2 3 3 P- P- Y P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9v - SS j JAI [ l j E P 0 A ~o ✓ -l o ~o t (~1 r - E I.. 6 F t Ifo I t n "1t.~ c~ f I, the undersigns here certify tha I tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative nd that the r ded and the location of the tests are correct to the best of my knowledge and belief. F NAME (print): TESTS WERE COMPLETED ON: ads /A}Z ADDRESS: CERTIFICATION NUMBER: HONE NUMBER (optional ago u. ctc Sy s a o P?iJ Y9Z-$Y~~ CST all NATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - , INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Peecolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand K - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. UNPLAT TED LANDS BY OWNER N.88044 '001Y 456.90 152_30' ------152.30 `F I NI k)l a °j co a a 00 pi ~1 o LOT 1 3 LOT 2 w LOT 3 68,217 S0. FT r~ 68,,--17 SO. FT. N 68,217 SO. FT a 1.57 AC. o 1.57 AC. o 1.57 AC. a i °o o j = o CiI O 2 3 r io id ✓O/NT ACCESS EASEMENT i TO LOTS / a 1 FOR . p~ I h DRIVEWAY PURPOSES. 2 -----.ti -/50.99'----- ~io' io' -----X50.99'-----ti- -------%5099'----- ~ k S. 88 °44 0/ E. 452.97 38.99' / to 79 . ~ R / w W P. m a. 210 th Avenue pn S. 88 ° 34 '/0 1E. 452.68' M -34'10-E . /30/. 37 R/W - - SOUTh SEC. /3, UNPLATTED LANDS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 3707 (ILHR 83.0811) & Chapter 145), LOCATION: SECTF61r- ! TOWNSHIP/MUNICIPALITY: T N .:BLK : SUED SI 3w 4 Sw 4 1'3 /T31 N/Ri E for) W CO UNTY:, MA AD R 1V83- Q26f At. P1. , DATES OBSERVATIONS MADE /Residence ? -SCRIPTIO ~Nrv ❑Replace PROFILE yo Z 2 27- Q? RATING: S- Site suitable for system U- Site unsuitable for system OUN - 'SYSTEM. N ❑u M®s Q~ - [Du a FU L 4K L ~G®, ]RECOMMENDED SYSTEM: optional) f It Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: JW4 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING AL H TOGROUN ATER-INCH CHARACTER OF-0-11 WITH THICKNESS, COLOR, TEXTURE, AND DEPTH INUMBER DEPTH IN. ELEVATION gS RV D TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) B- / 9v 9y, y',~' 9~ ° io , 0.1 ail,,T ~loL' CS (PL o' p J 8-a6,e!Sy 5,, .,76-39'-~h Gh.s 8- 7, 89 9y 8 , 8 9 ~39 _rf9;5-,1ej 9y. SS o-8" 6//1 8-aP B. 3 $S 3 ',~sti3.' ate- 39• ~ s Q Cr ex A" e- 8~ 1 Y, fJ > 8 to Q-/o + 'd?/~ ~o ~o ~ .20 -.j8`0 S, ' sle, s B. &17Ji . Yo -yj-" y - t s B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DRC A - HE RAT MINUTE'S NUMBER I;vCHES AFTER SWELLING INTERVAL-MIN. PER INCH P. P- P- P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- mtai and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent f land slope. i PYSTEM ELEVATION 90 . S.~ 41 -2t 1'4-tN zw_a T-7 --7- I'_. j ! L---.l 41 4"1 1 1 1 1 the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin dminirtrative Code, and that the data recorded and the location of the tern are uorruct to the port of my knowlolluo and holiuf. AME print)* TESTS WERE COMPLETED ON: s - "?.s CRRTIFI -A ION NUMDBH: PHOHNNNUMNIA 111+1 11 aid !1....~.u,- I~IttIMl.I~IIINI O111III101 MIIIIIIIINI!HIIY IN 1 IIPM1111111!HIIIY 1111g101IV UYV11111 1,1111 111,11 1041111 II_IJl~_Iltll! II!lui, 111 IIUtIII i S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /err 1-041de- ADDRESS- /O t~ Jrt: FIRE NUMBER CITY/STATE _NeU) R%C.CA1+ dA C1, Lji . ZIP- ~[7/~ PROPERTY LOCATION: -SW1/4, SECTION , T3/ N-R-18_W TOWN OF -!n-A . PeA1'QN* . , St. Croix County, SUBDIVISION (!~00a)'fr2~/ °14C~d&J.S , LOT NUMBER f 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/lle, 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: q DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completcd in full and signed by fthe owner(s) of the property being developed. Any inadequacies will only result ~n delays of the permit issuance. ,Should this development be intended for resale by owner/cohtractor,(spec house), thenla 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 L vnlcle Location of property_l/4 SW 1/4, Section •T-I_N-R_LLW Township ` SfiA R ~eAiRi Mailing address Pd. Cox 63'60 .S cgol r FA-II.S. /A),, S/o.2y Address of site 812'-Ale... ll)e.iu ~I ~d subdivision name_ Coy,u+,Qy He'4dow s Lot no. Other homes on property? Yes--)( No Previous owner of property Total•size of parcel ..5r c ~ ~ 7 A x Date parcel-was created , 'Are all corners and lot lines identifiable? ' Yes No Is this property 10eing developed for (spec house)?.Yes No Volume,-272and.Page Number --53) as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in thin informr ::ion form, by virtue of a warranty deed recorded i the office of the County Register of Deeds as Document No. ID 20 y , and that z (we) own the proposed site for the sewage disposal system orreISe(we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly r ecorc~d „~rgth :ice of County Register of deeds as Document No. recd Signature of-applicant c'o-applicant 93 Date of Signature Date of Signature it I DOCUMENT NO, o WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 - 1982 xF~. ~ it II I Pennis-.....A. Tornio and..Nancy.. C, Zbrnio, husband and u. wife conveys and warrants to .....A7,1,~ Lunde•.an d (-iary Brunelik as tenants. in-•corrrmon 5 .b% a-96 'Development I j RETURN TO the following described real estate in .St. .CS'.OIX County, State of Wisconsin: Tax Parcel No: I Part of the South one-half of the Southwest Quarter (S112 of SW1/4) of j Section 13, T31N, R18W, described as follows: Comment corner of said Section 13, also being the ~ at the Southwest i~ ' ing point of beginning; thence North 00'13137" West along the West line of the Southwest i Section 13, 1289.05 feet; thence South 88'51111" East Quarter the North fli edof the said Southwest Quarter of Southwest Quarter (SWk of SW-k) and Southeast II Quarter of Southwest Quarter (SE'k of SW-k), 2227.26 feet; thence South 00'16127" West, 1299.80 feet; thence North 88'34'10" West along the South line of the Southwest Quarter (SA) of said Section 13, 2216.18 feet to the point of beginning; EXCEPT Certified Survey Map filed May 2, 1 ' Y 979 in Volume 113", Page 795; and EXCEPT Certified Survey Map filed September 14, 1979 in Volume 3, Page 863; and EXCEPT Certified Survey Map filed September 28, 1988 in Volume 7, Page j! 2029; and EXCEPT Certified Survey Map filed November 20, 1989, in Volume 11811 II page 2174; and EXCEPT Lots 4 and 5 of Certified Survey Map filed March 26, 1992 jl in Volume "911, Page 2467; all in St. Croix County, Wisconsin. i *Grantees agree not to place a driveway closer than 135 feet from the westerl boun- dary of the above described property and "Grantors a y driveway on Lot 4 of Certified Survey Map, Vol, g not to place a feet from the easterly boundary 9, Page e 2 2467, closer than 65 of said Lot 4. *their heirs, successors and assigns. This iS not homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. i this . day of ......,.08?' Novrwy~ 2 II jt~" (SEAL) . nnis A. Tornio L.~ (SEAL) Nan c WC. Tornio . (SEAL) (SEAL) * AUTHENTICATION r: ACKNOWLEDGMENT Signature(s) ----1)e inis..A.,..Tornio Nancy C. TOrniO STATE OF WISCONSIN . cvrw;;:.h~cr......... ss. I~ authenticated this !qv' 92 County. day of 19...... Personally came before me this . day of .......1- S q _-v II II~~''.................................... . I& 19 the above named Krishna Ogland II „.ITLE: MEMBER STATE BAR OF WISCONSIN gyp.. (If not- ' authorized y § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina 0gland t~--••-• t-'~.w' ~ e Notary Public County, Wis. giq(Sigltatures may be authenticated or acknowledged. Both No Commission is . ;4fwe not necessary.) permanent. (If not, state expiration date 02Am- of persons signing in any capacity should "P be typed or printed below their signatures. ~•a~WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. FORM No. 2 - 1092 RAiI usu4ua WL. ST. CROIX COUNTY WISCONSIN _ 1 ZONING OFFICE r r n r r r ONE rornb ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 cco~'/o December 17, 1993 Allen Lunde Valley Custom Homes P.O. Box 686 St. Croix Falls, WI 54024 Dear Mr. Lunde: An inspection of the septic system for the Valley Custom Homes property, located in the SW 1/4 of the SW 1/4 of Section 13, T31N- R18W, Lot #1, Country Meadows Subdivision, Town of Star Prairie, was conducted on October 18, 1993. At the time of the inspection this septic system was found to be code compliant for a three bedroom home. Should you have any questions, please feel free to contact this office. ,S#cerely, Y.. James Thompson Assistant Zoning Administrator js