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HomeMy WebLinkAbout040-1215-10-000 o ~ Co y ti p 6 cv a o o I 0 N O x I r L U) c O C z C O lL c f0 O 07 I ~ ~ p Q d' ~ N rn ~ Z E I Z ~ °°(w am o ~ 0 O z v u Q5 r o m H o 1 ~ - 0) N ch a) m 'C N > • N N O C C O U Q - Z I- Z w z N - ° N V O c0 N o d to U-) a ; U c W 0) , N I > O O O. -0 (D w o M fn fn o N C7 v r o 0 1'- FL a. O O O •NN =CL IL IL ~i a , N p y M M v N J U rn rn Z M L p Lo .J O N N CL U.) Lo E o o m ao n w 'a N Q rn ~ r 'd Q z n o o an U) = C) cc) U) !1 p co N C O co E N CO O o M o E c d a c o ~ o °o r ~ E -O N N V Q ~ M p ~ O N C 0~ I l=yam') N I- C y U N 41 -0 p O O R U 0 ; N T L M - N 'p L • O O H p z C Z CO ° w el I o m ~ a I L: IL E c0i ,c c o r A uIL2 I,Oinv STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER T© m C a h~ ADDRESS 131C) SJ:?kSS e SUBDIVISION / CSM# MeA ~U Ul-- LOT # SECTION . T Z--~- N-R__Z,,9 W, Town of ~V ® Y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s j I 26 3r Id INDICATE NORTH ARROW y° Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. I BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /0?.50 Setback from: Well House Other Pump: Manufacturer Ar/A- Model# AJ ZA- Size_0/_ Float seperation nr/A Gallons/cycle: 10 AA Alarm 'Location ru h SOIL ABSORPTION SYSTEM Width: S Length 7 Number of trenches -.3 Distance & Direction to nearest prop. line: 023 Setback from: well: 7 O House~_ Other ELEVATIONS Building Sewer f0/, ST Inlet: ST outlet ~QDr3~ PC inlet A PC bottom Pump Off Header/Manifold Bottom of 'system Existing Grade Final grade 3/ DATE OF INSTALLATION: 7 --2 PLUMBER ON JOB: C a~ l y ► r ~p ~/`S LICENSE NUMBER: 1-5 (03 INSPECTOR: 3/93:jt +A rfsi~~ artr ln~u ry28.19.103~~ d IV~E ATGeSYSfP TH PACIF County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 193411 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /00 ,yyz~ G5 -E /6 040-1215-10-000 TANK INFORMATION ELEVATION DATA A9300073 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ - b Benchmark q, 7 5 101,75 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet g. TANK SETBACK INFORMATION St/ Ht Outlet q y~ ibo , 3~/ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 7 TO ' 73/ y / NA Dt Bottom r .a6 v9 Dosing NA Header/Man. s 9 v-S v 48.35 Aeration NA Dist. Pipe a°y 9-1.3L Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand r' % 7a ~bc~,D 32, Model Number GPM TDH Lift Friction Syesatem TDH Ft oss _T_ Forcemain Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O 'eZ77 CHAMBER Mode Number: 0 / ~ 7 U ,4. OR UNIT System: ~ /~G~ 2 3 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.) C7 7, LOCATION: TROY 16.28.19.1034,SE,NW, LOT 41, SOUTH PACIFIC l~~S 1 r _9t, N'a Plan revision required? ❑ Yes ❑ No / c~ Ia Use other side for additional information. lzr_ SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: L SANITARY PERMIT APPLICATION E:rjOILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMI # -.Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / 8% x 11 inches in size. c ec if re ion to pre sous 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 ICIVI-N, 5e-h f1. Y05 5 Y4 /VIA Y4, S / T N, R or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 13/15 5-t 4SSer. r / Ar CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 10 (A S+ V- .,kV 5 S L1~ -67 / 7 G b utA_ c>trL+-ft r,- II. TYPE OF B ILDING: (Check one) CITY : NEAREST RO ( ❑ State owned VILLAGE ` Sswf~ QG i ❑ Public )AJ 1 or 2 Fam. Dwelling-# of bedrooms Z PARCEL Ax N III. BUILDING USE: (If building type is public, check all that apply) 0 yo " a 1 S - 1 O - 1) 60 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.[K New 2. El Replacement 3. ❑ 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 y REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 96ii 7 ELEVATION C►~0 /(7106 /00 'VIA, 3, !v Feet 9d', 6k"l Feet f.11 - VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New ' istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tans Tanks structed Septic Tank or Holdin Tank ~bz7 r( ~1 S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (P Plumber's Si atu : (N Stamps) WMPRSW No.: Business Phone Number: ' Plumber's Address (Street, City, State, Zip Code): 41~ kZAj C S_$e6j 7 IX. COUNTY/DEPARTMENT USE ONLY e ❑ Disapproved Sanitary Permit Fee (includes Groundwater rrr_.te Issued Issuing Agent signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) /0 1 Adverse Determinati 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. Asanitary permit is valid for two (2) years. 2. Y~ur sanitary permit may be renewed before the expiration date, and at the time of re!re n•al any new t criteria in the Wi;consin Administrative Code will be applicable. 3. All revisions to this permit must be approved by tile permit issejing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SI?;) 6„9S) to be submitted to the county prior, to insta!la,tipn. 5. OnsifA- seWAge systems must be property maintai ed. The tank(s) muS:r ! . ='I y ci licensed pumper,whenever necessary, usually eyefy 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code adlf.in►strLtor or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. • - < - , 1. ~ _ To be comWete and,.qEcurate this sanitary permit application. must include: 1. Property. owner's name and mailing address. Provide the legal description and parcel tax rnjmber(s) of where-the system isRto.be installed" II. Type of building being served. Check only o-ie 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, -eccnr,ection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system, information. Provide all information realjestr-0 :-l ~ t--7. VII. Tank informatior. ¢ ?in the capacity of -very new and/or e } r !ist the r lal gal .n ; nurnber-of tanks and manufacturer's name. Indicate prefab or site consti i~ o rand tank material. (,r( r etE for all septic; to+wnp/siphon and holding tanks for this system. Check el--:) i=Tental approvai tanks 'eceived expr.,; ertal product approval from DILHR.. VIII. Respcr~sibility statement. Installing p!umher is to fill in name, li " N it,mber with app j7 (r i~ ie rrefi) (e.g. MP, address and phone number. Plumber must sign app! .::gin !orm. IX. County/ Department Use Only. X. County/ Department Use Only. Compete ,-,tans and spec..ifications not sr-tiller than 81/2 x 11 inc!!es must h(-, °jubrnitted to tll- county. The plans rrus, include the following: A) plo' plan, drawn to sca!f, 7;r with c:or iple'te dimensicrs, .nation of ho!dirg tank(s), septic tank(s) c,r other °rearment tanks: but ~ tiers a!is; water, + vator service; strearns ano lakes; pump or siphon tank -;istribution htoxt~3, s,,,, AbgOr, t ;systems; <<. ;.erY pni system areas and i!re location of the building .ze:ed; 8) horizonta r 'rtica' referent- pouts,; C) complete specifications for pumps and controls; dose voiurtE_. elevation cilferences; fr.ction loss; pump performanc@cpCIe; pump model and pump manufacturer; D) crass section of the soil atsorptior system if-.® :rjequired by tf-3e=county; E) $oil test data on a:]1`? form; and F) all", ltb 44nformation. - - - - - - - - - - - - - - - - - - - - - GROUNbWA'FER SUACHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices v hich can ?ffect groundwater. .The Mon e; cooeoted th oum`i the$e.sClrcharges are u sec f ,_r t ,!rr~water, brit f~i r Water contamination Inv+„ !i(7dt cans and establishment irT Ors i?tt5. i " SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Tom Schank & Melissa Anderson Location of property SE 1/4 NW 1/4, Section 16 , T 28 N-R 19 W Township Troy Mailing address 1310 Stassen Dr. W. St. Paul, MN 55118 Address of site Subdivision name Glover Station Lot number 41 Previous owner of property Lt,i,A"cty\ C+1j~ t"ki s Total size of parcel ~.aJr AC, Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes _ ,No Volume /-"-7 and Page Number S 3 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, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION 1(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 dead recorded in the Office of the County Register of Deeds as Document No. 76 2 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County gist of Deeds, as Document No. Signature of Owner Sign ure of C Owner (If Applicable) Date of Sig ature Date o Signature -;UMENT NO. STATE BAR OF WISCONSIN FORM 1-19821, ; THIS SPAr- I, WARRANTY DEED 497769 VOL 1003PE 532 - This Deed, made between E---Z-EKIEL----------- LU-----•--TH-------•ERAN--CIIURCH i AE - - - Grantor, - - and------THOMAS--R.-__SCHANK_-and--MELISSA----.--AN-- DERSON--------------------- > ~~--_IP_MAl?ITAL--PE?OPERTY------------------------------------ Grantee, Witnesseth, That the said Grantor, for a valuable consideration--_-__ RETURN TO conveys to Grantee the following described real estate in _St. _.CrQl?C-___---_•---__- County, State of W isconsi i : Tax Parcel No- Lot 41, Glover Station Second Addition, Town of Troy, St. Croix County, Wisconsin. i TR. - FOU This -S - not _ homestead property. (is) (is not) Together with all wid singular the hereditaments and appurtenances thereunto belonging; And.... Ez_ai_el-_Latheran. Church- of_River__Falls-..__-_------------------------------------._---__-.-_---.-_-_-_-__._ warrants that the title is ;ood, indefeasible in fee simple and free and clear of encumbrances except municipal and zoning ordinances, easements for public utilities, and building restrictions of record, and will warrant and defend the same. Dated this day of April--- 19---93_. -EZEKIEL LUTHE OF,RIVER FALLS - (SEAL) - (SEAL) Randall PC-u-d President - ---------(SEAL) \ (SEAL) - - - - - - - - - - (SEAL) - - - - - Secretary (Luane Davis) i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. St,__ Croix-------------------County. authenticated this __._____day of___________________________ 19______ Personally came before me this 14- -...day of A '1 1993 the bove named - - ----(k h11 L)t: _h e-•I- 4-v-1S------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ---iice~.,~ nn authorized by § 706.)6, Wis. Stats.) to me known to be the person ___"Y`~vd QW"the foregoing instrument and acknowlejop"SMUC THIS INSTRUMENT WA 5 DRAFTED BY - C___M_ FYe------ AgaT _ C• C In//)~LL Notary Public _St.__CT'O]X------------------- County, Wis. (Signatures may be authelticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: - _ir3.) , 19__ •Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leeal Blank Co. Inc. FORM No. 1 - 1982 Milwaukee Wis STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Tom Schank & Melissa Anderson ROUTE/BOX NUMBER 1310 Stassen Dr. FIRE NO. CITY/STATE W. St. Paul, MN ZIP 55118 PROPERTY LOCATION: SE 1/4 NW 1/4, Section 16 , T 28 N, R 19 W, Town of Troy , St. Croix County, Subdivision Glover Station , Lot No. 41 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper 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. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED I& DATE -T& St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address Aj2PENU M To o f iG%~~ c- f'E;A9R 1-' 0F 5- f 3 Wisconsin Depar"*nt of Industry, SOIL AND SITE EVALUATION REPORT Page of L Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY f. If 0/ X 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 PROPERTY OWNER: PROPERTY LOCATION ~q TOM 5c44vtt i Aclm+ ,~,v~ ,psd GOVT. LOT SF 1/4 VAJ 1/4,S/& T2 N,R ' I E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1310 STfFSSG`.v f ' zf/ G/ov£i s2i+7_10.v CITY, STATE ZIP CODE PHONE NUMBER EICITY ❑VILLAGE EFOWN NEAREST ROAD w • $r mr, `t /yv. SS l!8 (C Cm yS5-0 71 7 7X0 15,0. Fi'c [ j] New Construction Use KI Residential / Number of bedrooms 3 - y [ ) Addition to existing building j J Replacement [ ] Public or commercial describe YSa - Code derived daily flow &,oo gpd Recommended design loading rate 4114 bed, gpd/ft2 ' S trench, gpd/f: Absorption area required 1114- bed, ft2 trench, ft2 Maximum design loading rate 1144- bed, gpd/ft2 ' S trench, gpd/ft2 E It (as referred to site plan benchmark) Recommended infiltration surface elevation(s) 5E,6 Z l Additional design/ site considerations ZISE T~~~ ~.S ©N y - oN 5 /op w~ Duo r3 iJ~ -D f'S ~2 r Q V T/ D 1 Parent material SC- s ~i s yews .f5 /3 vtPr,6 1WT Flood plain elevation, if applicable A24 It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem 93S ❑ U ❑ S Mu RIS ❑ U ❑ S ®U ❑ S J au ❑ S U ~c_1CCE-_'Z~it.- S/opts SOIL DESCRIPTION REPORT ring # Depth Dominant Color Mottles Texture Structure Consistence Boux~ry Roots GPD/ft Bo Horizon in. Munsell (Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rench E] 0-/0 7o g 3/3 77 777 nw f R f S /42- lo yX 31y f, s6k A-^f/t' Ground 16-2-S2 /D Yoe y 1, Shr ~?S O elev. It C 75 YX y~~ S &A, 9P (M C s i x , Depth to - g~ 2•5 Vie. 41¢ - 5~ 1, + 9X nr ~F l ~S l~ limiting O fact~~ Remarks: lj 'ei00.4 C /5 1^0.v~V u.f //y B ~fA.$,0E,0 R Boring # _ /O f/c' 313 Sl l,f 5-hk ,~-,f X - S 4 07 X Z 9 ~y -7 - /o y Y3 s/ , f, 1 /Wf /Z S JUf .h /P /D //P S/ f s6~ ft° s &f Ground 17 J ~C elev. Yle 7/,- ~ f 56&- tovNf t" C~J /~rF K 3 ft 4m fv'l 'e- Y2- le 311(e Depth to M limiting S Y4 4l 7 $ I, ~n -F r / - S factor „ 9L Remarks: DO/vvl~// 5~l/E of /.3.}~~lroE 4,f,12 it°i7o✓ ~Z fo rf ~,P~X• (ad"OcSa , CST Name:-Please Print Phone: 71J _ 3 O Q I ©,5- dress: MESITE SEPTIC PLUMBING CO. 655 0'N Signature: ROBERT ULBRIGHT Date: .J / 3 CST Number: CIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 00S T M w 1► " !K)TALLER & DESIGNER LIC. NO. 00663 aC - arc .S`~~d -S d~ /z fo 2 0 ~o Tif'jfJe,45 N ~ ZlS-eD 7/O 11,44 0119t- 'Af4X t_-9 'AM 1ia/-t/ltl,~,11fr Aeov ~JP/'Zc9-v C w Li 'C~t / S ~o~SiSf~;vf /!G TEAV,4 n el 4A YCkS of e -f ~YS 6,A i65755- 0166e,v 10 2 fv r~/d~/f4 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPj/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench [3i Ground elec. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # '4K'~M. * AA Ground elev. ft. Depth to limiting factor Remarks: NOMESITE SEPTIC PLUMBW CO. ill 3 $t~kiwS - z! SF 3 7R' ~.v u,f es;g O'NEIL ROBERHUDSON, OOSrM 1~8z WIS. MASTER PLUMBER LIC. NO. 3307 M.PAS. J( o MINN. INSTALLER & OESKMER LIC. NO. 00663 ~ ZG~t FD~~ O OVA TO JO OF pI*p,` B~ . A-PPhx. /OCI, Q ' i ' t3 ~F l ~ n S .30 ~ ys N4 Z , 40 9z' 4CL Nt= W E LIE-7L) O l0 IE vtroa S q vc5 RECr,~RD V Of REpOPt _FPvm Y-S-q3 S • = P/ fs C3 /o~. yo SGhLE : 30" w s f3. 47,0 fare A-rR=rt- z fag 9/. i,,r ~ . sutttST-e t 4 , ~ Sy STEM ~'ftv't-riOVs 9 9i-.SG 1 2~~ -rIZeN D MiD tP E a75 Of ;~o low -rv e, v e4 60 5 yST~t-~ ~'I~c~hTl'd~S ~Nsffi// sysf~-mss %v MP ZOO 'G 04.1ZI f TE-peapi a G- 0Ac lfee~9~- 5E-p-O rev ( as -Taco- (3-1-r / Lott 2- To p r&74 '`fa&- E^ei, sree' cp reeX044 /cw•r-r~o-~ - Ex sec rs h I, S C-Sc p- le7fiI a Aj w/' /i ~'s ohi.✓ SD u /,*cf `lc c L. W consin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but l✓T c'etq 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: IYVA5 5 PROPERTY LOCATION GOVT. LOT SE 1/4 A10114,S loo T 2, N,R 17 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # / 31o 5~~9.ss ,v !911? • y/ 0"'-/0v6-P sr f rio,v CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®fOWN NEAREST ROAD Gv. 5T ALIZ 11V 5S1/,f ((,iz-) = 0 717 r•eo E ~~T Soak wit ~i~'. c (XJ New Construction Use [ J Residential / Number of bedrooms 3 y z [ J Addition to existing building j J Replacement Y O [ ] Public or commercial describe ^ Code derived daily flow &oo gpd Recommended design loading rate S bed, gpd/ft2 G trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ' S bed, gpd/ft2 trench, gpolft2 Recommended infiltration surface elevation(s) 3 ft (as referred to site plan benchmark) p s 7 ae i Q u oti/ Additional design / site consi erations ?.1 S E' ` R e AJ C 5 0A.1 y/ - 401;""k 'a v /sox Parent material ACS /~yR~f'h~FRDT - ov~w.rsh' 101,41A5, Flood plain elevation, if applicable It S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN R HOLDING TANK U = Unsuitable fors stem EIS ❑ U (as ❑ U ®S ❑ U S ❑ U ❑ S MULL S ~U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon ice; Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence 13ourxiary Roots Bed Trench 0-7 /o R 3/ S/ z ,f 56e yN ~,P s z f S , 7-yf /o X -p - is o s 7 . Ground C `/~-gyp /o y,e z,`F, sb ^,,,f f( elev. ft. Depth to limiting factor Remarks: ~{p~iw v "C f /3-fvas Boring # ' o io yr' 3/ s/ 2, -F, s6iC n,., va, s 2f 2 ~ ~ , io-yy /o y,~ y 5/ 2-f, s~k .w,fe S • S -G 13, FY -60 /o y,e y (Q /S o AM, 1r►,,2 cS 7 Ground v f elev. C O-gip Sl ye . S - G ft. Depth to limiting factor 02 , Remarks: CST Name:-Please Print Phone: 1-71 Ott Address: 655 O'NEIL RD., HUDSON, WIS. 54016 Signature: liAe-i 1S MASTER PLUMBER LIC. NO. 3307 M.P.R.$ Date: q3 CST Num~ry~Z " WN tN' TALLER & DESIGNER LIC. NO. 00663 9 10 ORIGINAL ti~v ~0 f ~yy PROPERTY OWNER A) SOIL DESCRIPTION REPORT Page Of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw-d3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench /00 l S 4} . G Ground C 1 /dY/2 y 2,~ 9~ M^ie Is - ele,. ft. Depth to limiting factor 7/00 Remarks: °i~iZo~✓ ley~~h vs /~OGt~~ TS of lo,,~e f16 Boring # 0-/0 /O y ,Q 3/ 2Sdk ,va, fie 2--f- /0 -/,v ib y,P A.V%f S l , S , dp.Y~ 10Y~e y/!p f w-f 03- lvf 7 1,0 Ground 'AV S S,G` /'M1 j' / • y elev. ~ Y~ ft. / o YA A141 Depth to limiting _factor z1d_ y H49VwR yS 7T'-`1 - / S S o j S .S so v,g L L Remarks: S,9 TU~°g TAD . Boring # O_(e 10YIe 31Sb,C ~w,fiE S 2-f- ,S , G 4 /,t sit /w-FR , s Ground elev. ft Depth to limiting factor - /~E3j(r-v fifC7z~p PS7- 13F . Remarks: /5 /,3, P,&79 oV Boring # O _ & Al 3/ `Fie S 2'F . S G Ili > _ Ty /o ~/R y Ground /Jz Y / elev. ft C ' y 1011f skt ~1 {i( _ i S 106 Depth to d" IT T W y - j ~ ,►til "s KM limiting factor s Remarks: i' ZD-✓ " G i S /.3i},vD - 7~S i f~ c Tam = . S e C. con onnnio nrin'" i 'i 13D,e~ 7 is v%/? Tv /1y f,~ D>~r.~, ~ ~~5cp~ptro.~s ~N r3 oe ~ # ~ . i i . r I 40 t3 f~y BS 77. 7-3, FS P~`Ts S U (,,G E S TC-0 S Y S TE,1-l L r= V /t-T I` v NS 30(o user- 7'ec-OeA s 6u1•I'li R,eop /90x D:sre aorn.~, lf~c TREN&L - 9y 70 M I'pDIE ~-~eEac-4.. _ ~ ~ 4 O ~ II B 7 ~YO s ysT~~ ,6 , . 3 / , Sep" /3M / y S+t EL u~2r~'c.~~ RrF 1~t• / 13s i P -top of p kovL- pt7~#~ 9g0-z 3` ~ //0 • ~ y 10 ~ R JIVl7 # q i ~U~`fESir~ ~ PC- e 7(0 - ~3 36 T3z W a HOMESITE SEPTIC PLUMBING CO. II, 655 O'NEIL RD., HUDSON. WIS. ROBERT ULBRIGHT c'ST6-AE ly~Z ms. MASTER PLUMBER LIC. NO. 3307 M.P.R.& iPgt 4CeAfe tJT ;INN, IMSTALLER & DESIGNER LIC. 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