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HomeMy WebLinkAbout042-1101-20-200 -0 CD M C I o a O I ~ I e I 0 N I o I ~ I c I 0 ti I r I I cn o c z I _ f6 d C U. y 3 -U I f6 i ¢ a ~ I v (D z y I 3 o O Z I - o v E o z ~ I d m rn w a m N M ~ z o I ozV a i o V) o I v~~~ rn z ~ c E v I y N a' y I C • N N O_ N L L_ ~ C O I z Fes- z 0 z I N c c 10 C14 41 y. N v H ~ ~ v co y a > O- °o °o 0 o a N M L w Q p j o fn fA f/~ y CD C O O Z r> z 0 0 I Z •N ; ~CL CL CL tv a ~a a g r 7 O U) N to W J V rn rn } ~ rn v I airno 04 I E 1 y o o _ > m c a n L rn N N v ¢I ~ in m I o C Lo ' I o c`no ti c C, 0 O c c m ol No ac. rarnooo 10 e l U o o~ H c o o c 04 y cu H H o c 0) °rn I~ *4 N N N E M r 7 - L o y E E R ) • O ' O M co o z y fQ ~ I U IL Gi 7 a - d = c i r`iw~1 'c _1 A co IL O ai ci i ST. CROIX COUNTY a WISCONSIN k ~~,;_;•.e~;.;.< _ 9~- , :r ZONING OFFICE ST. CROIX COUNTY COURT HOUSE 1101 Carmichael Road Hudson, WI 540 1 (715) 386-4680 August 3, 1993 TO: To Whom It May Concern FROM: St. Croix County Zoning RE: Mark Simon septic installation: 1465 70th Ave., Roberts, WI 54023 known as the NW-',, NE;, Sec. 36, T29N-R18W, Town of Warren, St. Croix Co., WI. St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on July 16, 1993 and revealed that the newly constructed portion of the system was designed and installed in accordance with all local and state requirements. Enclosed is a copy of the inspection report for your use. Should you have any questions, please feel free to contact this office. nncerely, James K. Thompson Assistant Zoning Administrator js STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 14 ADDRESS SUBDIVISION / CSM# LOT # SECTION_,3 6 T;?? N-R/_W, Town of Glfar~4J~yC~ 1b U.2t .1If , 5511 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 166 w 1-70 ys~ p , p P C3ox loo 4 / I N CATE NORTH ARROW , Provide setback and elevation inform i~ revers this form. A I W Provide 2 dimensions to center of septic tank manhole cover. • r 1 BENCHMARK: add - ©d ALTERNATE BM: 4VA SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Pro Liquid Capaciay:~~iL©© Setback from: Well 7 9/ House_ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length 7 S Number of trenches 2- 7 A Distance & Direction to nearest prop. line: N Setback from: well:~f jyv 'House Other lizo ELEVATIONS i / Building Sewer ST Inlet; 09, ST outlet (O PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade 0 '3 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3 ~-~0 INSPECTOR: 3/93:jt r~ S `a -'te`a g ~s, LQWXr9AartA WXsttP - 29.18.5 P' ~ AO E SY M County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division erm (ATTACH TO PERMIT) sanitary it oERITX GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: CST BM E ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 161), S 46Y TANK INFORMATION ELEVATION DATA A9300036 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / , Benchmark /4), OD "14 - Dosing S7 113-21 ~ 3 Aeration Bldg. Sewer L Holding St/ Inlet TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake - Septic >lAd Ze NA Dt Bottom J - - 5/2 IN Dosing NA Header/ 7B9" 97,7~~ Aeration NA Dist. Pipe Bot. System Holding I PUMP/ SIPHON INFORMATION Final Grade Leo 39 Manufactur Demand Model Number GPM TDH Lift Friction System e H Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width , Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O P c_tl i Model Number: System: <r%/~~ 2C~~ OR UNIT DISTRIBUTION SYSTEM Header /-MOR44e101 Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent To Air Intake Length Z6~ Dia Length Q-2Z 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 .Trench Center Bcd / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION,: WARREN 36.29 8.55S7~,NW,NE, 70TH AVE. 1 Plan revision required? ❑ Yes U160 Use other side for additional informatio cry. / SBD-6710 (R 05/91) - / Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t a i i i, 3 i , I SANITARY PERMIT APPLICATION 7 01LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -A'tt~ach complete plans (to the county copy only) for the system, on paper not less than ❑ 8fz x 11 inches in size. Ch k re Nitlpr~ls application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER a PROPERTY LOCATION 0 - 5 Lgyl rr~ NW Y. S T91 , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 309 n1 1q, N CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER i~ cre~^- Q 579D oo1 1(7/;5r 793y6 , II. TYPE OF BUILDING: (Check one) El State Owned VILLLLAGE : NEAREST ROAD I41 0 ❑ Public N 1 or 2 Fam. Dwelling-#of bedrooms PARCEL Ax NUMBER(S) `f~ - lid/ -AV 111. BUILDING USE: (If building type is public, check all that a apply) o 41,R - l l o l A 1 El 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 g ❑ Office/Factory 13 ❑ Other: Specify IV. TY PE OF PERMIT: (Check only one in line A. Check line B if #p cable) A) 1. [E New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 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 600 9 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) jl. 1 oa. • Ef_E~aOJy, r, gOFeet /o2.SFeet 7:5-0 '7 6-0 N 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 Tanks Tanks strutted Septic Tank or Holdin Tank oZaO /0-o0 Q,", 54 F1 F1 1 0 Lift Pump Tank/Siphon Chamber Ej Ll El I L] -LF]Lf F-1 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 Signature: (No Stamps) MP/ PRM SW No.: Business Phone Number: Ale~,~VI'11&d W V. cv5- r~y7-33,X;2- Plumber's Address (Street, City, State, Zip Code): 6 7 14 d IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S 'tary Permit Fee (Includes Groundwater a e ssue Issuing A nt Sign Lo Sta ) Approved ❑ Owner Given Initial Surcharge Fee) - Adverse D rmin i n p v~~~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 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 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 it 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 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) 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 Makl ) calf ~ ~itYlbf`j Location of property ~1/4 ~_1/4, Section j4, T,~N-R W Township W 0.M.9--,,.. Mailing address 1A) e Address of site _Y11f Subdivision name__ IV. A, Lot number AIA, Previous owner of property h(iwc a,( aYIS~ C~o Total size of parcel 76 o..ens-.t, Date parcel was created -NY\. 6~ , ` q Q Are all corners and lot lines identifiable? Yes No is this property being developed for resale (spec house)? Yes ✓ No Volume 9OI and Page Number ,574/ 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. PROPERTY OWNER CERTIFICATION A We) certify that all statements on this form are true to the best of 01~ (our) knowledge; that A (we),'4 (are) the owner(s) of the property described in this information form, by virtue of a warrant yy,, deed recorded in the Office of the County Register of Deeds as Document No. y(oq/ g~ • ; and that (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 Register gf Deeds, as Document No. JAJ° Q- Signature of Owner Sig tune of Co-Owner (If Applicable) Date of Signature Date of Signature 4k i 01 M! 4 DOCUMENT No. WARRANTY DEED !HIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FOlkK 2-1982;'! 4C9180 ISTER'S OFFICE Dorwes Fa}I*S 4,Jnc• , a sconsin ecd for Record Corporat ran - 4 t , . , , MAY 9a t'rWRegister CROIX CO., WI cit coneys and warran$4 M 0 . ark W. On and JOdli! M• . ! S.i.mon, sbarld...xid..t _f.e holding as--.,~- of Deeds survivo>ip mar itaP lY.rtY..:.... ! ~I .................'p. ~ I RI'.lll1:N IC) First National Bank of Baldwin - !i PO Box 145 the following described real estate in " Baldwin WI 54002 State of Wisconsin: Tax Parcel No Northeast Quarter of Northwest Quarter (NEq of NW4) and Northwest Quarter and Northeast Quarter (NW4 of NEq) of Section Thirty-six (36), Township Twenty-nine (29) North, Range Eighteen (18) West, EXCEPT Lot One (1) of Certified Survey Map in Volume 11511, page 1386. Subject to the roadway easement described in said Certified Survey Map. vqZ - llol - ao CT;4 ZD Q~t~- llvi [?,ANSF_ $./0S 3_ FE' This 1 - - - - - - - S..... 110t homestead property. 19W(is not) Exception to warranties: Easements and restrictions of record . Dated this 3 day of a ,19.91 DOR S FARMS, INC. . y ` r ........(SEAL) . . . (SEAL) *David Cowles, President . . .(SEAL) (SEA L) * * Doris.-.Cov1e.s., ..Secreta.ry. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. County. authenticated this day of 19 Personally ~~jcame before me this ...3rd------- day of O 1 19._91.. the above named A4yid•••Q.Q.wles_t_..Pres ident---and Doris.-Cowles.;...Secretary.............. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, 10111sn118111 authorized by § 706.06, Wis. Stats.) ~~V to be the p on wh ec QQ • ~i inst umen~ a Wl a th ame. THIS INSTRUMENT WAS DRAFTED BY r 0 / Thomas A. McCormack ` y.. - 1Z1. G hln'...--•-•.---•-------------------- Baldwin, WI 54002 e- . - 4• Palic ---St,---0r'oiX-------------------- Countv, Wis. (Signatures may be authenticated or acknowledt tf~ 60%...... iission is permanent. (If not, state exl,iration are not necessary.) Notwy PublicStebe of W oi~h Of 1H~6 i* C0140181" 80iftOtt-30:'198 19 ) 'Names of persons signing in any capacity should be typed or printed below their signatures. 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Jo)usJO .E pun emgs ew!l ❑ ad/4 pus Ban puel pelewgs3 11 s1!un q - Allwel-!11nW ❑ (u!eldxe) Jaylo ❑ j , 1R(G h wn!umpum/Alpel elBu!S s6uipl!nq pug puel U y 0/ F-1 F-1 legugp SOU ❑ e Aluo puel ~ eouep!saJ Sam penelsueJ) A1JadoJd l! ssBJppE m8N - ssajppV llnj 'Z asn AJewud gl A1Jadcud to put9l, 3S(1 AHVWltid 9NVAL04 dlli0S30 1V01SAHd 'A :801 aruanaU to luawlJedaQ u!suo0s!M IVIAMUN00 - N81' E13JSNVUI 31b1S3 Id38 b" STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ BUYER Map, zl~~ 7061 E__ Ls rn00 ROUTE/BOX NUMBER_ FIRE NO. CITY/STATE ZIP PROPERTY LOCATION: A(01/4 r 1/4, Section ? T_jg_J_N R 6 W Town of QNLs"' , St. Croix County, Subdivision A/( , Lot No. /U. A, 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 DATE 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 Lws nd artment o ustry, SOIL AND SITE EVALUATION REPORT Page L of -3 Human ns. Division of Safety & Buildings 3' Z' 93 in accord with ILHR 83.05, Wis. Adm. Code Mli Tom'. TEsr cavPlrlev5 : Svvvy, 30°f y"FiPOsT COUNTY S - G~PpiX Attach complete site plan on paper not less than 81/2 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. fl 'dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED 07 DATE PROPERTY OWNER: PROPERTY LOCATION /1/ 0v S1~vO4) GOVT. LOT 41ul 1 /4 NE 1/4,S 3 &T Z9 N.R /e E (or) W PROPER OWNER-S! MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Plr-ItS 4,,V T eSM 6.uD1o6_AfAr or- 7? Jc4t 5 C~~ ~ ~~5 ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 19OWN NEAREST ROAD S Yo Z S (7/5) 79f- 34G/ 6v1fR,pE.! 749 -ft;.. A UZ [,~J New Construction Use [XI Residential / Number of bedrooms 3 fO (j Addition to existing buildina (I Replacement [ Publieti! W. F11-1 lemaid de l__ D ~iPi~t 2 "-vr- / yso - Code derived daily flow loon gpd Recommended design loading rate • 7 bed, gpd/(t2 • ~ trench, 1polft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate - 7 bed, gpd$ ' f trench, gpd/ft2 Recommended infiltration surface elevation(s) it (as referred to site plan benchmark) Additional design/ site considerations JPE ~A yEtiT Agl~g ~I Ss _ 13~ Mo~.~~ srsTC~y . Parent material S'/-Ty SE~i:yc- LoEsS ZIti. 1c,41f Hood plain elevation, it applicable y It $ _ Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable br stem ®S ❑ U S❑ U D S ❑ U ie" ❑ U ❑ S ® U ❑ S U SCj b fAowe 43 De, C Z SOIL DESCRIPTION REPORT 074e-064 - /0/407- Gd y OleX Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourldaly Roots GP /ft in; Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed rEiric 1 /0YX 2/z S,/ / f 5h& ;f 3 E /o yie ~3 /og y i f 56,& Ar . y j Ground /3" /y ay /d y' he s . G t>Iev. ft. 8 2. 3y_ y xe 0,441„y,~ 7 -J0 Depth to C YP-100 110Y9 51,? 7 limiting ~fac/OD i ~OosE' , Remarks: ~/oRiyDN G l~s 1~tl 5 ) f /o y~t10 5/' P 77- L Boring # tol /o YA 2 2 S / z.f, sbk ^,,,fR 5 /cry J-1 Z - /Z /0 Y,e y/3 'ol 7W /t , Y = S I J3' Z - z/ /o yR Y13 Ground elev. 82 z/- yL /o yip O, 'W , y e ~rYt.Q S , 7 It. Depth to . limiting /r i zoc~ ~G cep ,vS / All ~'o-v :uu,} factor „ L Remarks: T Name:-Please Print F OMESITE SEPTIC PLUMBING CO. Phone: 71.S . 3 P6 . Ja/ P,5- Address: ROBERT ULBRIGHT Signature: G / ";iN INSTALLER & DESIGNER LIC. NO. 00663 Date: 3 _ Z _ 53 CST Number: 2 y~Z "'116 MASTER PI:UMBER 61G. NO. 8807 M.P.R.S. I i i I c(opy PROPERTY OWNER /WA f< 51M4" SOIL DESCRIPTION REPORT Page?- of PARCELIA.# PST V / G~~S Depth Dominant Co!or Mottles Texture Structure Consistence Baurclwy Roots 'GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed tench EI 0 , /0 yc ~Z s./ a t rhk Al 4 -fie s 110 -l3 /o y~e 3 , ~,e s /vf NP , z Ground 3- /0 Y4 y / 2- S6,r .~f0- 5 . . 5 elev. Dept, to X~3 y- Am X- C,5 , 7 , p limiting d ' Factor " ~-ID ~o W 5/p S , 7 •00 Remarks: Boring # la of P-/3 /D y/e ¢/3 . s . !3 3 - 30 /D Y S/ z, s6 '-w-6e 5 1-f ~ Ground O Q /1'y1 ~ 7 elev. /?i 0- yL Al /Q y/e es ft. Depth to uniting Remarks: Boring # 0-1,s 2-f, Sh& nMf4 G rJ e y S f 54e ew-75e <:~5 310 , 2 3 zf . G A T-30 0 5,4t -F't C5 Gmund /32 p - a o yrP /s ,,w„~ s - 7 .d' ~fR Ole Depth to i IV l~p /p Zd•U C C .t> ~.}i v S MA ~ 3 C O•V •w/ L AJ 44 . ~o yle 3/l0 Mgs ~E .S / o r 1- Remarks: 47' V40"- :,K L]o ,V/y &1&7-, Boring # - -7 /a yR z/Z .51/ F 7-12- SOYA y/3 -5/ z.f s6~ --RR s )uf s G Ground elev. /0 We S/~ A P pi, vflQ S • S • G it Depth to limitlng 115 Remarks: cif G Co,v~./~;vs M.~.cJy L 3 ~'o•u fi:~df L cor% o AcMn, RANDS aF A0 rX 316 ,4f4-f s~'vE s/ ~fra / ~ E ~ A" 1A '4 M-r/ 4D4u S<ST~-v e-1, 13.,t ,94;v 6- , f iw6x ROE- l C TES ~if'E~f- ~O / s' /vO 7" Sv~'T/j,~/E ~iP /t v /w -Jr~PO~v,0 C~tiv,!-V7-,0-c.),4 e- lolf A'e 1/'V zp ch c •G ( ell • y LA -4 N zt" Umi~CC~ + R L5 C5 ~ i, \ s 98 rl o d Q, ip -53 053 05 C L s w c • ~ m ~ 4 p o 0 0 Ic J, 2O ~ro ~ ~ In o N t~~• o °O o, ti r 016 ~n ~uiv,A.PoCV of ~jy1-i~°D 4~ovl~S w o, 0 w ,o 0 fi W a ~7 Y 1 C4, CC) _ o o r Soo 36 O m ~o 13 0 y o 'ID - T ~ G a. q 3 31ba p~' 1JNONd 5908-L£6-Z l9 im „ Zll8-Z5L-008 gS1vM oidialem 9996-LE6-Z l9 .auoydalal b691-bVE99 NW `auieJd uaP3 Imis y#8L 'M Xes5 uoijejodioo sailddnS ojdja}eM Wisconsin Department Industry, L of Laborand Human Relations SOIL AND SITE EVALUATION REPORT Page - Division of Safety & Buildings _3-,-,,,SOIL " 2 - 43 in accord with ILHR 83.05, Wis. Adm. Code COUNTY ~f/%nl?Ei TESY co~V ~~TiD,v 5 Svvu y ~ 3D °7~ y " ~iPOsT S T G,POIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limitedto 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. O 97- 0 -14D APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: ~j~ n v SiMON PROPERTY LOCATION I) IC GOVT. LOT *UJ 1/4 &E 1/4,S 3 &T 2-9 N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME 3 0 9 P 1,C--1t.5 h N T e5M Ewo1,v _ /o%er o S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 27OWN NEAREST ROAD Re)'eow7-5 Gv•s . 6' 9 ro23 ( 713) Ivy- 3 4/~e'/ 4VAfkfAl 70 4 tee. . JAI New Construction Use ]X] Residential / Number of bedrooms 3 fO ] Addition to existing builds [ ] Replacement [ D f~iPi~l /P'2i / yso - Code derived daily flow &00 gpd Recommended design loading rate / bed, gpd/ft2 . JV trench, gpd1ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate - 7 bed, gpd/ft2 ' trench, gpd1ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations A r sT 13,-- Moz1u,0 sy STC•y Parent material s'LTy S~G~ y~ S LoEss 7,tNf~°L.¢~,~ Flood plain elevation, if applicable ft u S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL MOLDING TANK U= Unsuitable fors stem. OS ❑ U @ S ❑ U 2S ❑ U 21 S0 U ❑ S ®U ❑ S RU SCS ( stipw,- 4,5 'DeC7- SOIL DESCRIPTION REPORT .07i441cT4 - P1/loT K Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bolrciary Roots (Fp-ljlft,Tl in; Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tends -7-0-// /0YX 2-/2- 56,E /M ~e S /UF k z 3 log `t./3 /o,tij ~ f 56,t; lwfe /5 1-70 Ground 8, ~y 3y lo ye ~2',w# he ~ ~,P ms's i . S , G elev. ft. f3 2- 3y-1 it, xe l,, ,m, 9,( km e- , 7 - ~ Depth to G' y_ sap limiting factor 5 Remarks: 11017-61N G X#5 ~~t/ AS} v1~5 o~ /oGZSE /D Y?e S?? IS, Boring # /0 YA 211, Z_ 2.f, S6k IL4 0 Y,,e Z11 -2 fit 441 7W /7"- S 71 /2-2_//00 y/3 Ground Sh elev. ~3Z 2-1- ft. yi/o yp Jp C 1-~00 ~oy/f 51,0L 7 Depth to , limiting / /f /2-0A.) factor ,>/00 f3f},VQ j D ~DOJE Remarks: T Name: Please Print YOMESITE SEPTIC PLUMBING CO. Phone: 71..S ~ 3 ?G ~ 4?1 d ,5- r Address: ROBERT ULBRIGt'T Signature: e "11% MA6:FER PLUMBER 61G. Pie. t3ag;' M-P,R.S. INSTALLER & DESIGNER LiC. NO. 00663 Date: 3 _ Z _ CST Number: Z %Pz v $ g ORIGINAL. { tG C` _ .2 .3 1 l - 0 A (.A) PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of PARCEL I.D.: PST 0/0 /f Depth Dominant Color Mottles Texture Structure Consistence GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y Roots Bed rends r 0-P /0 Y4 21 - 5'// . f shk ~fi~ s / , s Z_ V-13 /a yR 4ZI-2 Ground 13 I R /D y/e y Z, S/I,C J f~ s . s elev. ft s hk Depth to /.S" Q, Amt C,5 7 , limiting D factor yje S d, t , 5 11A Remarks: Boring x# 0 _ of L~Z z, Sb~ JWI7ie S /uF - s f/3 "5 Ground elev. ~z O - 412- /40 le D, A", 9/e L' S 7 ft. C , Depth to limiting fact + Remarks: Boring~# Dys Sh& 6Mf4 3f , j G -/a /o Ley 3 'S~ f s,6J~ -,W C-5 310 , 2- y 3 x-30 0 4", stir C5 2--F 5 . G Ground elev. 1-32- O -Yo 0 Yof IS , 7 J~ ~f ~Fs o, of MA Vf Depth to limiting fp ~p factor C C ,0 ~4i v,s 103 C O-tJ Ili.vl~ G ~v o1 Ags ;Pe- S / o r I' Remarks: Boring # 07 - Ili yR 2-12- E 71 Z /0YX Y/3 s/ 2, sbx f2 s lu~F s , G /S 7 Ground n c Z 9 elev. ft G /0 P 4,4 2 s ~f, l`if Vf IQ f s , s Depth to limiting factor „ Remarks: ~OJ'C ZO,y "C " e0,o" A~1;vS 44,4,V OK L ~ -/-0 3 ~'O•v fi:uvif L con oonnio ncmrn N &F Yo< 31G AIs?1,4 1 ,QA Ds L '(V ~ 10T 0O.V -Cle Ar ) 61 . /mil , s rJD •%U Gv/f~ J Acv r. / 60 I-S 7- .Svi'T/f,~/E /.U ' friPOv vD ~Ca,u402!~7-v77i4)-v,,f L s~ fi, G S/s'7~.~y Rio u,~ p sys r~-~-~ ~ (h to 4, . a 00 A rn a n a. 5 m C S' C ~1 N m m 4 x 1t1 U1 • ZA7D~jr Q m z of rh o Z rt, O a b .p ~ `Morn ~ d v - p m x ~ c.Jrn t~ ~ O p o 0 0 6~ ~ -mv • ` N . 3 ~ 41 W ~V D W ~ ^Q O ~ W 'T.PMlR. /rN~ L}PPiPOX . E,}S % ~iPdfJ. G i %vE