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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ar r.T~~~c~ h cL `e
ADDRESS °j Zi.O / - IIJCVILQA
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SUBDIVISION / CSM# LOT # .J
SECTION a,~T 3/ N-R / ~W, Aiz-44
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this-form.
Provide 2 dimensions to center of septic tank manhole cover.
i t I
BENCHMARK: 61F Blgq
ALTERNATE BM:
SEPTIC TANK
Manufacturer: LiA.4,Se h Liquid Capacity: /add
Setback from: Well 79 °J Other
Pump: Manufacturer AA Model# Size
Float seperation Gallons/cycle: T'-
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: -5 Length Number of trenches /
Distance & Direction to nearest prop. line: /S
Setback from: well: House 0 O
ELEVATIONS
Building Sewer 991 / ST Inlet; 47,21-5 ST outlet 9 7..
PC inlet PC bottom Pump Off
Header/Manifold - Bottom of system
Existing Grade Final grade 9 y
DATE OF INSTALLATION: 15 PLUMBER ON JOB: 4"
LICENSE NUMBER: 5 ~3
INSPECTOR:
3/93:jt
Wiscnnsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
ab and Human Relations INSPECTION REPORT St. Croix
tfe and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
"GENERAL INFORMATION SE,SW,Sec.25,T31-R18,Hwy. 65 193459
Permit Holder's Name: k] City ❑ Village ❑ Town of: State Plan ID No.:
Plourde, Lawrence New Richmond
CST BM Elev.: Insp BM Elev.: BM Description: Parcel Tax No.:
!GJ.C! /r",~v,,Q 261-1211-10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
~iy~.
Aeration Bldg. Sewer
Holding St / L-d Inlet 7.3-31 i 7 L2
TANK SETBACK INFORMATION St/ 1f outlet - S 717
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header 1AAftn- (o
Aeration NA Dist. Pipe UZ qG-
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade k2f '99,07
Ma rer Demand 9S ~50
Model Number GPM
TDH Lift Friction System Ft
Forcemain Length Dia. If Dist.Towell SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Length No. Of Trenches PIT Inside Dia. Liquid Depth
DIMENSIONS d DIMEN
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manua er:
SETBACK CHAMBER
INFORMATION Type Of ~ 3 Model Number.
System:,/-,-,* ~ 5~ ~sd Ae OR UNIT
DISTRIBUTION SYSTEM
Header / 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 i „ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
-{Trench Center vB O/Trench Edges Topsoil C] Yes E] Is ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
SE,SW,Sec.25,T3,,11/--~~R18,Hwy. 651 /
,
Plan revision required? ❑ Yes to
Use other side for additional information. 7V /
SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: l
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SANITARY PERMIT APPLICATION
•In accord with ILHR 83.05, Wis. Adm. Code COUNTY
RLHR . ` G ra ,
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STATE SANITARY PER IT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /4' 3`/ S Y
8% X 11 inches in size. Check i revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
a w ret" Cs e_ `i' I b u~ W-8 le_ SE '/4 5 w Y4, S o?5 T 3/ , N, R I or) W
PROPERTY OWNER'S MAILING ADDRESS LOT #
%a 9 / jl~j WA &26 ru -5 °w
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
CITY "c NEAREST ROOF
11. TYPE OF BUILDING: (Check one) 11
P Stat Owned VILLAGE': ❑ Public 1-gads-~Ewe~~~ ~~ee s
L e ,
111. BUILDING USE: (If building type is public, check all that apply) 7 a5 - O L_ Cal Z ' 4()
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 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. New 2. ❑ 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
lJr -WoVSl ~S lSr'8 i 7 IV )X 95. Feet 99,) Feet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank F1 F-1 I r7_
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
PI ber's Name Plumber's Sign at (No Stamps) r MPRSW No.: Business Phone Number:
C~r~.~utn 7f~-~►"S 4563 7/ y6 -S~~s
Plumbp
/ 76 r '"Address (Street, Zip Code): a ,
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved 1tary Permit Fee (Includes Groundwater FT75--te ssue issuing A I'ant Sig
vAproved ❑ Owner Given Initial / ~ Surcharge Fee) 00f J . `rZp
Adverse Determination Q(/
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 sanit ,ry permit is valid for two (2) years. `
2. Your 9anitafy`permit may be renewed before the expiration date, and at the time of renew.--d any new
criteria in the Wisconsin Administrative Code will be appiicable.
3. All revisions to this permit must be approved by the permit :.;suing authority.
4. Changes 4). ownership or plumber requires a Sanitary Penoit Transfer/Renewal Form ( E 6399) to be
sub r?ii ed to the county prior.tp installation.
5. Ors- 't'P sew-g#.-s stems must be properly maintainer:;. -t;r? :>3ptic tank(s) •*fiust be Yi? s-` z= ! V a. i'icensedf
purr',per wheni ve'f-necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code ariminis'trator or the
State of Wisconsin, Safety & Buildings, Division, 608-266-3815.
To be complete and;eccuratelthit ~a&titary permit applic iflon must include:
I. Property pwper's name and mailing addr9ss. Provide the legal description and parcel tax number(s) of
where the systeTf is to be in94116d. i
II. Type of building beirig served` Check o* one and complete of bedrooms if 1 or 2 Family 'Dwelli ng.
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 pine B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending en system type.
VI. Absor,3tion system information. Provide a!' information requested in. 01-7.
VII. Tank :reformation. Fill rr the capacity of ever;, new and/or existing t ! , : total gaiiar;s, r;umbsr of
tanks and nanu!acturer's name. Indicate prefab or site constructed en : :F rk riiatei ia1. (11 0r.l (--,te (cr all
septic purr;p/sigh.,) , and bolding tanks for this system. Check exper ! !r;proval only it tanks received
exper mt;,n. pr~.)djct ;3npt!Ival from DIL.HR.
VIII Resptir ns~b!hty statement. instaiiing plumber is to fill in name, license with appropria~e pre'ix (e.g.
MP, e'c.), addre:3s and phone number. Plumber must sign application lc"•rri.
IX. County/Department Use Only.
X. Court.//Department Use Only.
Compete plans and specifications not srnal!er than 3% x 11 'ttU. i be -,ubm tted to th(county. The
plans mr~:;t include the following: A) plot p;an, drawn to sca•(, ct o;iiplete dinnension3, 1)cation of
holdir g tink(s), septic tank(:,) Gtr other treatment tanks; brj,lJ!ng ae ;:3; w;;ier rn it s!water service;
strearlis and lakss; purTrp or ; phon tanks, distribution boxes, soli ;ibso,p o- systems, (E'1)11(ffr-enl system
, ea3' and `lie locatlc)n of ~ e buuding ser`. d,, horizonta: and vertlca; Iev ration 'efercrice F,olnt;;
C) cor:nplete specifications to, pumps and controls; close volume; elevat _,n 6,141erences; frict on loss; pump
performance cutve; pump model and pump manufacturer; D) cross section of the sorption system if
required by4tre-c ounty; E) soil1est data on a 115 form; and`Fyadf g-informati4 " b
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a ntlr n,?r of
re3.ulated practices which can effect groundwater.
rr.
j'
The mcm Fs col ected througfi ttjeise surcharges are jsed or ~ d.v te, ti r>urd
water contamination investiyatir,ns and establishrr;En of star: airis.
1
SBD-6398 (R.11/88)
e
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 Q W r;e. hc-e_. P) ecu v'd'q_
Location of property ,~_1/4 1/9, Section Q r, , T N-R W
C~J
N
Mailing address vehrit~ A:ck
Address of site S PQ ~ 7
-Subdivision name N ~kc-~"" Q1y~ ~or~
Lot number
Previous owner of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? Yes X o
Volume and Page Number 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
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. ; and that I (We)
presently 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
constru tion of said system, and the same has been duly recorded in the Office
of th unty Reglst r of Deeds, as Document No.
ignature of Owner Signature of Co-Owner (If Applicable)
. !
Date of Signature Date of Signature
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7 066
1-li=)rdGAR AREA LEASE
THIS AGREEMENT, made and entered into on the date indicated below
by and between the City of New Richmond, state of Wisconsin, a municipal.
corporation, hereinafter- called the Lessor, and
hereinafter called the Lessee.
WITNESSETH:
WHEREAS, the Lessor owns and operates an airport known as the
New Richmond Municipal Airport and said Lessee is desirous.of leasing from
the Lessor a certain parcel of land on the said airport, hereinafter more
fully described, for the purpose of aircraft storage; and
WH TEAS, the Lessee will use the below described property for the
purpose of oring aircraft and shall conduct only such aircraft
maintena e on its own aircraft as performed by the Lessee or by regular
employ s of the Lessee.
NOW, THEREFORE, for and in consideration of the rental charges,
covenants, and agreements herein contained, the Lessee does hereby hire,
take and lease from the Lessor and the Lessor does hereby grant, demise
and lease unto the Lessee the following premised, rights, and easements on
and to the airport URpn' the following terms and conditions:
1. -Agperty-._Descr-igtion_ (Include lot number from Land Use
Map, square footage of land and map if applicable.)
y9dl
Lot 5, Row 71 Airport Layout Plan dated Sept. 1, 1989 being 5920 sq. ft.
i~iangar_Gorlstruction. The Lessee shall have the right to
erect, maintain and alter buildings or structures upon said premises
providing such buildings or structures conform to the applicable
requirements of the Wisconsin Department of Industry, Labor & Human
Relations and pertinent provisions of any local ordinance in effect. All
plans for such buildings or structures shall be reviewed and approved in
writing by the Lessor- prior to construction.
Terms. The term of this 1. erica Shall be for a maximum
of ten (10) years; commencing on and ending on
June '0, ?t1U=~.
4. Rent. The Lessee agrees to pay to the Lessor for the use
of the premises, rights, and easements herein described, a yearly rental
of five (5) cents per square foot for the land leased, for a total annual
charge of 296,00payable on July 1 annually. It is understood and
agreed that the rental rate herein specified shall be subject to
re-examination and read iustment at the end of each three year period of
this lease, provided that any readjustment of said present rates, or as
same may be amended hereafter, shall be reasonable-
5. Non-exclusive-Us-e. The Lessee shall have the right to
the non-exclusive use, in common with others, of the airport parking
areas, appurtenances and improvements thereon; the right to install,
operate, maintain and store, subject to the approval of the Lessor in the
interests of safety and convenience of all concerned, all equipment
necessary for the safe hangaring of the Lessee's aircraft, the right of
ingress to and egress from the demised premises, which right shall extend
to Lessee's employees, guests, and patrons; the right, in common with
others authorized to do so, to use common areas of the airport, including
runways, taxiways, aprons, roadways, and other conveniences for the
take--off, flying and landing of aircraft.
6. Laws _and __Regulations_ The Lessee agrees to observe and
obey during the term of this lease all laws, ordinances, rules and
regulations promulgated and enforced by the Lessor, and by other proper
authority having jurisdiction over the conduct of operations at the
airport.
Hold - Harml _ess_ The Lessee agrees to hold the Lessor free
and harmless from loss from each and every claim and demand of whatever
nature made upon the behalf of or by any person or persons for any
wrongful act or omission on the part of the Lessee, his agents or
employees, and from all loss or damages by reason of such acts or
omissions.
8. Insurance. The Lessee agrees that he will deposit with
the Lessor a policy of comprehensive liability insurance upon 9i) days
written notice from the Lessor.
9. The Lessee shall maintain the
structures occupied by him and the surrounding land premises in good order
and mate repairs as are necessary. No outside storage shall be permitted
except with the written approval of the Airport Commission. In the event
of fire or any other casualty to structures owned by the Lessee, the
Lessee shall either repair or replace the leased area to its original
condition; such action must be accomplished within 120 days of the date
the damage occurred. Upon petition by the Lessee, the Lessor may grant an
extension of time if it appears such extension is warranted.
10. _Right_to_Inspect. The Lessor reserves the right to enter
upon the premises at any reasonable time for the purpose of making any
inspection it may deem expedient to the proper enforcement of any of the
covenants or conditions of this agreement.
11. Ta>:es. The Lessee shall pay all taxes or assessments
that may be levied against the personal property of the Lessee or the
buildings which he may erect on lands leased exclusively to him.
1. Signs_ The Lessee agrees that no signs or advertising
matter may be erected without the consent of the Lessor.
13. Default. The Lessee shall be deemed in default upon:
a. Failure to pay rent within 30 days after due date;
b. The filing of a petition under the Federal Bankrupcy Act
or any amendment thereto including a petition for
reorganization or an arrangement;
C. The commenpement of a proceeding for dissolution or for
the appointment of a receiver;
d. The making of an assignment for the benefit of creditors
without the prior written consent of the Lessor;
e. Violation of any restrictions in this lease, or failure to
keep any of its covenants after written notice to cease
such violation and failure to correct such violation
within thirty days.
Default by the Lessee shall authorize the Lessor, at its option and
without legal proceedings, to declare this lease void, cancel the same,
and re--enter and take possession of the premises-
14. Title. Title to the buildings erected by the Lessor
shall remain with the Lessee and shall be transferable. Upon termination
of this lease, the Lessee may, at the option of the Lessor, remove the
buildings, all equipment and property therein and restore the leased
property to its original condition.
15. Smw __fiemo_a _v-l._ The Lessor ~ -
Lessor agrees to provide snow removal
services to the Lessee's leased premises in the hangar area. Such snow
removal shall be accomplished only after all runways, apron, and primary
taxiways have been first cleared.
16: L_ease_Tr_ansf_Pr__ The Lessee may not, at any time during
the time of this lease, assign, hypothecate or transfer this agreement or
any interest therein, without the consent of the Lessor.
17. Ai reort_UeveloErn~nt_ The Lessor reserves the right to
further develop or improve the landing area of the airport as it sees fit,
regardless of the desires or view of the Lessee, and without interference
or hinderance. If the development of the airport requires the relocation
of the Lessee, the Lessor agrees to provide a compatible location and
agrees to relocate all buildings or provide similar facilities for the
Lessee at no cost to the Lessee.
18. S_u_bo_rd_i_na_ti on_ C_1 ause. This lease shall be subordinate to
the provisions of any existing or future agreement between the Lessor and
the United States or the State of Wisconsin relative to the operation or
maintenance of the airport, the execution of which has been or may be
required as a condition precedent to the expenditure of federal or state
funds for the development of the airport. Furthermore, this lease may be
amended to include pvovi si ons required by these agreements with the United
States or the State of Wisconsin.
19. Abritnyt.ion. Any controversy or claim arising out of or
relating to this lease or any alleged breach thereof, which cannot be
settled between the parties, shall be settled by arbitration in accordance
with the rules of the American Arbitration Association, and judgement upon
the dispute rendered by the arbitrator(s) shall be final and binding on
the parties.
IYJ WI'Tt'dti_ G_AHEC1F, "Lhe } ie- h.ivf~ hereunto their- hands and seals
tt-. i. cJc}f 91 S' i n the C. tv of
Neevj Rich -torid, St. C::roix, County, Wisconsin.
IN THE i='r- ESENCE OF: LESSOR:
1
- - - A,i rport Manager
Ci _ CC~r~L-u~ Eiv:
LESSEE
_---/Ct _ ~!w?_s ryy_~_---- TITLE:
Subscribed and sworn to before me
this 1~ --day
Notary
My Commission E:~~ires: <S .9- y
ST C- 105 r'
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SEPTIC TANK MAINTENANCE AGREEMENT H
0
St. Croix County z
OWNER/BUYER q W h2 rc-Q. ~~ocay~d e \
l
ROUTE/BOX NUMBER ~020~ 141"e-11 4ye I /V fire Number
CITY/STATE i'6~iu4, ek- ilk". j~&-6&L, 'LIP
PROPERTY LOCATION: s Sw
!4, Section 6?5✓ , T '137/ N, R 01W,
-Tr of 1Q_We; AMtM4 St Croix County,
n~
Lot number-S-_.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists 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 treat-
ment 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 fa ling system,
which was in operation prior to July 1, 1978. St.. C.toix 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 veri-
fying that (1) the on-site wastew disposal system is in proper
operating condition and (2) after'4?spection and pumping (if nec-
essary), 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.
0
F
I/WE, the undersigned, have read the above requirements and agree 1
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- It
ment 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.
SICNE; / A
D A T E
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
NEW RICHMOND
June 8, 1993
Mr. Thomas C. Nelson
Zoning Administrator
824 Fourth St.
Hudson, Wi. 54016
Dear Mr. Nelson:
This is to confirm ownership of New Richmond Airport by the
City of New Richmond. This property was acquired from several
different sources and the deeds are recorded with the Register
of Deeds in Hudson. You may verify this information with
James O'Connell.
If you need any further information, please let me know.
Sincerely,
Ole ~~o. .
Helen E. Demulling
City Clerk-Treasurer
City of New Richmond 0 City Offices 0 156 East First Street 0 New Richmond, WI 54017 0 (715) 246-4268
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Wisconsin 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
5'1r Cres~k
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
La W 1"2 ✓l C -2 1 (z. r CA -e GOVT. LOT 5 F, 1/4 5 W 1/4,S -j T 3/ N,R lCor) W
PROPRT OWNERS MAILING AD SS LOT # SUBD. NAME OR CS #
« S ROW 7
CITY, TAT ZIP CODE PHONE NUMBER CITY []VILLAGE r OWN REST ROAD
( ) c. h wr csrid NEA &S
j New Construction Use [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow /so gpd Recommended design loading rate bed, gpd/ft2_itrench, gpd/ft2
Absorption area required .V_6 bed, ft2 / 8 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) C K bf ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material P, *4acJ e) -u*w o. s 1~ Flood plain elevation, if applicable 4/A ft
S = Suitable for system CONVENTIONAL MO ND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem S ❑ U [ S El U 19s ❑ U ❑ S au ❑ S BL El S NO
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundaly Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
o-s /,OXX 5/.M 57 o - 5IoK [ C W a 4 , 41
-S
a 5 -a3 i s - 5,1 / a m s bk m i- ; C Lo f 4 , s
6
Ground 3 a3 3l D K -5,/6 Is I rn M+ C w 'S
elev.
' C , 7 f!
9 9, /ft. 31
Depth to
limiting.
factor
Remarks:
Boring # _ S y jr
o /o t 5 S o- rn sly /h CL LM
a s - /9 /a R y - 5,/ ate, rn ,~w a,3 , y ,S
Ground
elev. P Y-* p 51L - s d ,r• yin / C W 7
Depth to
limiting
'tgry,.
Remarks:
CST Name:-Please Print /v dwt r h Phone:
Address: 6 ~ ue /Gf7Pn o-ncl tJ' 5- Y6/
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Signature: Dater CST Number:
PROPERTYOWNER LAW reh4p /9,161(ra4,SOIL DESCRIPTION REPORT Page ? of 3.
PARCEL I.D. #
Depth Dominant Color Mottles Structure `GPD/ft
Boring # Horizon in. Munsell Qu, Sz. Con, Color Texture Gr, Sz. Sh. Consistence Boundary Roots Bed Trench
0--y /o R 5i o m 5 b m G w 2S s-'x 10'g Z sbk mfg' cw t , 41 , s
Ground -3 6 /o K G S l i4L 0-0
- , 5
elev.
eft. 3/-~' /P S L S o !"q 1h C w - 1,7
.
Depth to
limiting
factor
Remarks: `
Boring # ;
os o O'wSb~ to )(S ~y s
z s~a~ ~P s, a~s6~t; m, ew a~ , y s
Ground -
elev. y 3o-~~ 0 /Q S S o S m/ y
ft.
Depth to
limiting
factor
Remarks: ,
Boring #
ds /d Q sj Sid o~ k ew 2S ,y `~S
5-27 Ale 2 5
14
1-21-2 14YX 3Z4 d")
Ground
elev. .yy 6 R y S S m C w ' 7
Depth to
limiting
f C~ V
Remarks:
Boring #
,L
Ground
elev.
f,
Depth to
limiting
factor
Remarks:
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PAGE OF
. CrrJSS Sec~tUn ~ _ Sys~e~
Fresh Air Iniels And Observation Pipe
C~k- Approved Vent Cap
Minimum 12" Above
Final Grade
20- 42" Above Pipe _4" Cast Iron
To Final Grade Vent Pipe
Mash Hay Or Synthetic Covering
Min. 2" Aggregate -
Over Pipe
Ol~trlbutlon - Tee
pipe 0 0 0 0
j 6" Aggregate o Perforated Pipe Below
Beneath Plpe
° -Coupling Terminating At
Bottom Of System
99,
Q~~~o5e1? ~Inw 11qr ~
"a n
SOIL. FILL
DISTRIBUTIOt.] PIPE APPROVED S(jWPETIC COVER
OR 9" OF STRAW
Z" OF AGGRE6A?E J OR (~ARSN HA"J
° (e OF 12-2tI2 AGGREGATE 41
MEV. OF?-5 FEET-..
DI•S•T111131]TIOM PIPE TU BE AT LEAST 11ICHE5 BELOW ORIGIMAL GRADE
AMU AT LEAST20 IMC14ES BUT 1.10 MORE THA J 42 IAICHES BELOW FILIAL GRADE
MAXIMUM WN OF EXCAVATIOP ROM oRI&INAa 6RAK- WILL BE. INCHES
/MINIMUM grTr4 0FEACAVATIOW FROM, 0IKI(.I1JAL GRaoF WILL BE ay INCHES
SIGI,IED:
LJGEUSE DUMBER:
a DATE. to r~ a"~