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HomeMy WebLinkAbout261-7000-07-005 7-5 Q o ~ 3: c; o O a ao R o E o i o D 7 ~v o 2S N Q Q) ~ 3 s U LO h ~ O N r O 3 c Z ~ o- I L m LL CO 'E Z ° C_ -0 c a Q S o O v y z y 00 w o L z ; l 0 d N a m o I O z d v a> Z ~ o C o fn F Z O z C y E -E Cl) -~V N 0- O N ) N ~ • N N C U.) o 0 z H z z N N m E o c E L y _ m co ~.l a 'm U v 3 o G G a .2 o Z L Z co H Fy- M 00 t- N 16 4 "OM 31 3: 0 0 0 0 a d z° • XCL aa a 0 fl. M M O N 0) C co NJUI'a } R7 O m N 2 d LY co cl) 2" O O ~ r O 0_ t E N C O U V O C C a ® E o 3 3 y a Q rn } o a~ N ~I r/ ° E E z z c o o rc-D o o o Lo H H i~l M I` > M o E E • O 7> N N U U O N 7 U) j 7t w £ f L 1 ate, d per, n L: CL 0 CL r A u a 0 to 0 e STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ar r.T~~~c~ h cL `e ADDRESS °j Zi.O / - IIJCVILQA _t S so 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 ~ n7' 6 _ s~ o 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 I I I, SANITARY PERMIT APPLICATION •In accord with ILHR 83.05, Wis. Adm. Code COUNTY RLHR . ` G ra , x 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 lt. U i / V '3 i k-3 5y a y~ -3aaz s ~ ~y 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' . r a 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 h~ AMO - i k-3 G o 5 I/ sy ~ y SN tis - 9 0 - 066 1 I `a l ~ ~ . . ~o/~ 9~ ~ x. i s t e~+ a,n~ r is 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/ f 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: SBD-8330(8.05192) , r r 1- i t I r }I 1 1 ~ ! ' ~ I I I 41 r------ -I--- ' ' -J. -_I-.-- i I I _ I I , _.1..IA-~,f.J I ' , r , i I I, l i l l l . ~ I I I I I I I ; I - { - i I I - f _L~-~ I 1 I I I ~ i I i L 'r_d r r I , I ~ I I I 4~ I I I I ' { I F I 1 ~ o- p I E~ I i I I I ~ I I i } ~P 1 - rl7 I , ' fRW 7 1 I I , I ~ ' f I I I ' i I ' , r I I I I ~ I I i I I ~ ~ I ~ i i I i t I I 1 1 I I V I I I I I _ I _ ~ I I i ~ I 0a4 7 - - t I I ~ ~ c i r I I t ~I I I I ( I 1 I i t ' , ' I i I I i I I : ' I I I ~ ~ I I i I I ~ I , I I , 4-1 - - - ' t I r I ~ I I = i ' ! I I i I I I I I ~ ~ I ! , I I I I I I ~ I I I I I I I { I : ~ I ~ I I I _ 1 f I i I I . I I I I I I I I i t s I' i I : I I i I I I , I i I I I ! I I l l t l l i l~ l ~I ~ l , I : h I I i I I I ~ I ! I i I ~I ~ I I II I ~ I ! I I i I I I. I I I t 1 ~ ~ I I I i ~ I ; I I I I I ~ i I I ~ 1 I I i ! T ; i I , f I I 1 I ~ I I ~ I I ~ I j I I l i I i I I ! ~ i. 1 _ I - I I I I I I I L i I 1 l -TL a I F I ' I I - I I I ! ~ I I I~ I, I ! I I I I ; all D Ir o _or I 1 To, T i n d kit 5 i I W w r -47 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"~