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HomeMy WebLinkAbout020-1009-40-400 (D °o N O I o ~ ~ I ~ I ° I 0 N I a I ° y C Q o 0 ;y N ~ N fi ~ I (0 S d o a Z C 1L C O O C Q =O i 3 Cl) Z w rn w E z o z m m w a m ° z o I c 0 z 2 o v c d Z C C (n F- r O Z C O 'Q m t4 S N a N N 1 Vl C C C O U Q Z H Z 0 I N z E N 4) N CL R c cfl m H m ° °o y G M a ~o N N~ ' Fy- FN- FN- =O m co O O O ° • ry a G. a a 7 O N O N N N fn J U rn rn 7 } c ~ I J CD n ° ~,a C N 7 `a ~ I ° O ~r c (fl c 00 Q 3 •o a c a _o ° _ O % N d> cy~ .O O~ U C O N Q1 N 0 _r_ ~ 0 O C r0 N • 7~ N 0 7 N W C N E f0 U 0 2 S O z_= U) O ~ I' I ~ xt E ~ I dt a' d a .c nrisconsin uepartment of Industry, SOIL AND SITE EVALUATION REPORT Page Labor and Human Relations of 3 D jsion bf Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but X 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: #4PROPERTY LOCATION GOVT. LOT /t'lJE 114WE-114,S/0 T 2y N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # !'OUvTje ` Ci7 Bv,P~G,iJIPO T STifTio.t> CITY, STATE ZIP CODE PHONE NUMBER QCITY []VILLAGE aOWN N REST ROAD v1~So-✓ w/S ya G (7is~ 3PG - l/1~ ,~vvso v - s P ~r°T 7Y 1W IN New Construction Use K J Residential / Number of bedrooms 3 -Ao [ ] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow D gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 _ trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 ,3trench, gpd/ft2 Recommended infiltration surface elevation(s) _ft (as referred to site plan benchmark) sw- P~ . 2_ Additional design/ site considerations,4440,':0 i~~~/ATE IA16-9 OF S eo A 13'7 - V V r017113 /E' 4,f t 4S Parent materials SD 1/1-07-S o~fw~s~ ~if/~s Flood plain elevation, it applicable ft s S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem I S❑ U EL S❑ U ®S ❑ U S❑ U ❑ S k7 U 0S ~ U SOIL DESCRIPTION REPORT t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP T In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trend; / D-/D /o ,e 313 S/ / { Afl le s Zti,, . z r mom o-L2-/0 y/z y 3 5 ;f si'e fiz s 3 Ground /32 ;-2 y0 7.5 Y X y S , 44V, S .v., C S / - 16 elev. w ft. ')epth to y0-/ /D J/,e S/ - S d, C 5 ';*'9 . CS . '7 siting /A L Remarks: 411, Sk -M L'3 o /b /e y 3 1,3 7 -j? fae 0 /D~/~ ✓r ` b cg-S~---r?: ©C, S ~'►t-C 0 I C arks: 11,0? ~ l7- r'nPTIC PLUIMING Cq,'~% 811- e Print RO ULBRiGHT Phone: do a out Sigr_ _ MINN. 116rALLER & DESIGNER LIC NO.00663 ?4d-4 Dat% -'!r- / CST Number: i a e.- =yam 2.. . PROPERTY OWNER SOIL DESCRIPTION REPORT Page okw3-~ ' PARCEL I.D. # LW- 7 - Q vflt-4fi/WT sT.rT/o-~ 14 Depth Dominant Color Mottles Texture Structure Consistence GPD/ft c. Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.Y Roots Bed Trench O X ✓ ? 3 e/ off ` ii :.,a-:r..~ _ V~ //ir ✓ It!/ > t 13 5-14110 yx YAK - - s// if sh,e "ww s 3+ -z 3 Ground ff 7.5 y % S ~ S /1►~,C _5 elev. X ft. ..,i Depth to C; 3,1-/ / o Y/2 S1l~ _t limiting factor 3 T/da - Remarks: Boring # _ 2 .3. /D .3/ fS S " ~ . L ,t L jj *Y6 /oYe y~ si / f, sd-r •~.~{2 ~s if Z 3 13, 36 -J~ 7, S Y18 412, 5,4, Ground elev. ft. I C z /!o to e s~ Depth to limiting factor - Remarks: Boring # 2 /DY,e313 - S / Z, sd/~ ~►►-►f/~ s 2, ~ -s'l f, SI~J~ s 3f . z 3 Ground - - elev. ft. Depth to limiting Vwf jF 'tact Remarks: Boring # Q/OVA y/Z S yf, s',k i►+ 4l ' Z 7 /0 /3 y 3 , ~C Nrl ~ •Ground elev. j ft., T L ,y is / E y r iJ Depth to l G~ wA /I c NO 5"01'7 tE C le limiting Ih C ,g L 7J NT l' O~ ~t L re O a factor - ARC ITI Remarks: SBD-8330(R.05/92) /o o. a y~ t ~ ~o ~~N~ I s/opE REP~~ Hoc~sE Mvs r ~~'E S3 Or AI- LF 4sr 2- 5' f= "A T C5 T' ? M C* . j yG 13 3 - - F i l i i 0 ~ ' I SU~ 5 ~ STED I I I,~I I , ICI i of YO I I j ICI I~I ~~i 4,4yoUr 1 ~y i~ I I~' I ih i I s S~opE ~h A i C ~G t L~ VATf0 A.).5 1 P0,!AESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 J 3 6 ROBERT ULBRIGHT ST 9`~ Z ~~L M. MPSTER PLUMBER LIC. NO. 3307 M.P.R.S. VtNN. IAtSTALLER & DESIGNER LIC. NO. 00663 ' - 3A~~hoF p~Ts /02-,70 y STS ~ tE V rl'o~,s This hest site APPROVED for a conventional septic system. y~. /00 . SO j avRk'1~ t--Pp T__ i i AS BUILT SANITARY SYSTEM REPORT OWNER -IC-1 ~ TOWNSHIP U p oI\j SECTION _1 o TN-R 9 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~IA~C~~ AK 5- )ON LOT-7-LOT SIZE PLAN VIEW M SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a Q7' 3 Bxorwor o 3v ~ N T INDIC E ORTH ARROW P' PA 100,0 BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK: Manufacturer: ul S Liquid Cap. Uo Rings used: a Manhole cover elev:~~- inal grade elev: (U Tank inlet elev.:10~.~ V- Tank outlet elev.: ~Ua• `a3 No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front Side , Rear`! Ft. No. of feet from: Well NV ;o , Building: - (Include (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear_Ft. Distance from: Well Building -`A-` F- 5 o to 0.0 iy - are "hZ lol-S 1 l0~•3$ t 0.04 11-by loQ' J 4 •89 SOIL ABSORPTION SYSTEM / 91.03 18.90 Bed: Trench-.3 Seepage Pit: L-OW ~ / Width: J Length T C)Number of Lines:-3-_Area Built Goo Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: i No. feet from nearest prop. line:Front , Side Rear Ft.3 8 ~ 1-~' No. feet from well:YVl~ IN No. feet from building ` HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: a INSPECTOR: DATE : °1 1 a PLUMBER ON JOB : a VV, n LICENSE NUMBER: 3 T 6/90:cj L County: Labor and Hua HurrmLan tred Relations bons 1O.29.19,R#kr~. WxGE SYSTEM Labor a Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 186529 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: HUDSON ?h E lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9200413 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet /j> ci z TANK SETBACK INFORMATION St/ Ht Outlet 1 N v /v~.to3 TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I NA Dt Bottom Septic 1:2 zZ a - Dosing NA Header/Man. o o a ;°o:° ll•ol 9 .63 b V t9a 89 Aeration NA Dist. Pipe 8.90 k\.%4 Holding Bot. System q sy I9a, o ~a,oy PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syesatem TDH Ft Forcemain Length Dia. HH Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: 3V OR UNIT 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.) LOCATION: HUDSON 10.29.1,NE,NE,LOT 7, SCOTT RD. Irk t!-o rq,r~~k R { 3 Plan revision required? ❑ Yes ❑ No Use other side for additional information. / E1~ ~a- to a- SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY R 5 Cho') STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. 1:1 Y%k56niop',flous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P ER OWNER PROPERTY LOCATION 9% AJE N.,S To1 ,N,R E(or)W PROPERTY OWNER'S ILING ADD SS LOT # BLOCK # 1 _2 _A C , STATE ZIP C DE Q%& PHONE N MBER SU ION NAME OR CSM NUMBER P111tbo 1117gq-1( NA - k ~ n , E:l CITY NEAREST ROAD 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : ❑ Public R1 or 2 Fam. Dwelling of bedrooms PAR X UMBER( uj:sa ) 111. BUILDING USE: (If building type is public, check all that apply) ;D 0 _ O0 l~ /1 0 1 ❑ Apt/Condo `9 l1 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 80 Mobile Home Park 1120 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) 1X New 2. ❑ Replacement 3. ❑ Replacement of 4. El 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 300 Specify Type 41 ❑ Holding Tank 12,K 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. S STEM ELEV. 7. FINAL GRADE V T c, r- S~ REQUIRED (sq. ft.) PRgPO~Sa (sq. ft.) (Gals/day/sq. ft.) ./i ch) g0L 0ATtOONw o -7S oo- _S- Feet f 3 6 Fe``//et VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New lExisting Gallons Tanks Concrete structed glass App. Tanks Tanks Se tic Tank or Holdin Tank - 144 0 tst Lift Pum Tank/Si hon Chamber Vill. 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 Sign : (No Stamps MP/MPRSW No.: Business Phone Number: 3 y o /1 38 0"() PI mber's Address (S reet, i , S te, Zip Code): I0 QU ' c, - AS of S _ L d t~ ) _r C . IX. COON DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (includes Groundwater a e ssue Issuing A m Si No m pproved ❑ Owner Given Initial 1Surcharge Fee) Z~ Vj4e C!~ Adverse Determi ation e 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. 2. Ybur`sanytary -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. t 5. Onsite seviage systems must-be properly maintained. The septic tahk s) must be pumped by a`iicensed pumper whenever necessary, usually every 2 to 3 years. r 6. If you have.questions concerning your onsite sewage system, contact your local code administrator 6e th,e State of Wisconsin, Safety & Buildings Divis6n,_.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..- 11. 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 if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f 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) 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 _41 &.,,ii j-;i, Location of propertyA),6'1/4 L1/4, Section T•ed N-R/91W Township _ Auls 15k) Mailing address 1328- ry.,BZ Address of site /3rc.•~f- Subdivision name R--. Y Lot no. Other homes on property? yes_. No Previous owner of property Total size of parcel j, / Date parcel was created /P lei 2/ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes X No Volume !land Page Number 3Qa as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, ;would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in 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) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. w - - ~•~/1 / mss:. ~ ~ , A / r, rI I Signature of applicant Co-applicant Date of Signature Date of Signature SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS: X378 ~4 SV FIRE NO: LOCATION•_AJE 1/4, AfC 1/4, SEC._ /J9 T_,z2_!~_N-R__J qW, TOWN OF: ST. CROIX COUNTY SUBDIVISION: /AIa 424 S~..~~G•~ LOT NO. 7 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 to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix county accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the 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 from will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned ?rave read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, hea:ei.n, as set by the Wisconsin DNR. Certification fcrm must be completed and returned to the St. Croix Country Zoning officer within 30 days of the three year expiration dare k SIGNED:_ 1 DATE : I~1C - 9 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 U- 0 •Z uol!»loit ~w,wsu•~ 1 +01It •.ln1lru!afY f/ lu>+l a•Gp A`p,•971141 al►it..3 '$l U _71 J O 'V Y 3 Q = falf '1111 't91 ?9'92 '-S M O+P!••+0 W f• /P•7 _•u1wDr 'flll 641 i• St Mil pw -SMS 'qll o p iow•i :iaari:~ri 't2/ Vu/ (t> l2'9C2 ou• 02'HZ Yt'HZ 'Sl'9C2 cr a rO.a776 .0 v-lr J.A. 00 7rn LSr) e1 tuo a. 4t.. 7110 1--41 as fusll"140 ou oa14t Q W /M,Ir. 10.0ON N Z w V K.IO.ooN .9'•11 \ w-K,IO.OON W = J 0 S o N = a 2 1. g sa > p w a y11 a r W J W z LL. Z Q J W J 0 O i • v w _ N W g 14 W u 1 0 O Y ~ p = W 1 h 6. , U- 0 ~ W = W `w on = V u w cc us 40 u 3 W g 1- V. 3 • 0 1.- Z r- K _s W< LL g s " 3 r+ / w W W d 2 N Z S u •I ai OZ > 0. O W W w r ~r lL ¢ u > J o g ew ~yo O =p 2 H Q w ii `o X ws ' _ _ O O W w a X x _ W O w~ W O N X O R« w w g b' O Q I H W W X < c; ! N N N W Q ; ~ 4~ w 00 0.[ If) x ~w1 ~,i1L70. Wf r wa e Q O I F I w z I awo sI w• w Vim: `Da; 0 ~ i \ r F"' N w . n O Ol 07w•Ifir 'a NOLL232 IO 0'1710 7101 •0 J 7Wl lir7 7w1 Ol 0701031131710 »r SONINVW OWOS[ W I V~iVJ • • i W 0, 7. • I in 4 o~ j Ow a w9 V w ° O W O►0• 110% » c . . _ O = r _ W N •r t ^ I si tc .R 2 - - - a ZO' 61 t A1.21,00.10S U S OVOM 11059 • -r. •w•ra • w , ' ioi '!ii "(W &r F a q 3 ~ ~ s O cc p . ti 4 r1 N r Labor and fiwnen Relations r u n f rape , a %J*'!*n of safety 3 B iongs in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST.ceo~X. Attach complete site plan _on paper not less than 81/2 x 11 inches in size. Plan must include, but not Gnrted to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. / dimensiosied north arrow. and location and distance to nearest road. REVIEWED BY . DATE kPPLIC ANT INFORMATION-PLEASE PRINT ALL INFORMATION , PROPERTY OWNER: PROPERTY LOCATION t> RI-Gk Af// GOVT. LOT A E' 1/4.v6-1/4,SIO T 29 NR E (a) W s PROPERTY OWNER'S MAILING ADDRESS LOT 1e BLOCK # SUBD. NAME OR CSM s t 7/ L' R U/mow G/,~~/E 7 8v~t',E'h.tRO T 574 1oN CITY, STATE S yd GE (7~ 3~GEA 9f ID,S~1IILlA S PT NE . a. 0PS" y; Y4 New Construction Use K I Residential ! Number of bedrooms 3 1o y [ ] Addition b existing buildin . t I Replacement y o _ (J Public or commercial describe Recommended design loading rate bed, 9P ' trench, Code defived daffy lbw oo gpd Absorption area required bed, ft2 trench, ft2 Maximum design loading rate • - bed; gpd/ft2 gpPd/(t2 Z Recommended infltmoon surface s It (as referred to site plan benchmark) Additional design / sitp considerations gvo%D i~,sPi?TF f~P9 Parent material s //oT S o~/w~f s~ ~i-~S Flood plain elevation, if applicable Of* - tt CONVe ION& MOLIND KGROUND PRESSURE AT GRADE SYSTM W FLL H%D1NG TAW( $ = SjN a fa systern U = Unsuitable for system W-S ❑ U QS ❑ U la s ❑ U S ❑ U ❑ S k7 U ❑ S AO U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color mottles Texture Structure Consistence Y Roots GPD/ft in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 'en". El o-io /0 3 3 /-f O-La /o y/e y 3 5 sd,e ~/2 .3 round 13s z' y0 75 I R S , s 100 G elev. A, orft %ell y Depth to C yo-/ ye S/ S d, c,s,2 -P limiting facto i (anor; i Remarks: Boring # 2 = J!' G yle 41, Z k-30 16YIe l Ground ' elev. C y 7-5-Y R J/~ s LO) /M s cs 1,7 ,0 -ft y,Pt//y Depth to limiting p /D y~ S s 0 C, S-~ . 7 factor Remarks: HOI.4ESITE SEPTIC PLUMBING CO. CST Name:-Please Print ROBERT ULBRIGHT Phone: ~~/:3 T>/_ ~l~~ls Address: J d Y Mm. INSTALLER 6 DESIGNER LAC. NO. 00663 S' nature: r~~/ ' - , n Date: 0 _ CST Number Jr ? PROPER7YOWt+IER iC/vas- /7T 1 SOIL DESCRIPTION<REP.ORT _ o P ':ELLD.i S'T.019_J Depth Dominant Color Mottles Texture Structure Consistence Y Roots tGPD Boring Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 Bed i 2 s6-P~2 S' G - /o X 313 Ground 75y 5 elev. , a .o,~/li,. 4 Depth • smiting - . _ _ _ . ~ e Remarks: 3 - S / 1 L ...3. Boring 10f,? 31 13 yG /oy/~ y.3 S~ / f, sdK ~,f2 i f 2. .3 3 13 . 3(,' S~ 7S yl2 f 'S ,y~1 rwr ,2 CS i- 1 Ground elev. Depth IQ factor ' Remarks: - S/ i, ► s6/~ fR S Z . s - G Boring # o-G /DY,P- 31-3 SV J-11.3 /31 MY -5 0 nGioundc-, i =fir S y~Pf1v~ ft j Depth to Gmi6ng factor Remarks: 2- 3 Boring 0-60 /0 vf, Sk k; 7vX.kti<w _ S;S2 71, /0 #-7 7-k 9 46 W-P Ground elev. it. j J6i IVAE7 Si 'L T" L N S 14 E` O 7- No 5-0,T lc- Depth to rwe limiting 't L CO A.) v~•t,T/'O•~ L S /~Y0 D ' factor v /,C- - w, Remarks: 1 Ile-IV - - S 8~0 S3~ R~p ---govSc- MvS T c.►'E t=2oM Tcs T- rteeE . I ,sV~ ~ ~ STEQ -~i Ih~ `hyovT yr • 137 '4 yo ~sE s Ole 4 Let)Atfo NOtXSITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 J 3 l ROBERT ULBRIGHT ST ~1' 2~L i U' Z. M-ASTER PLUMBER LIC. NO. 3X7 M.P.R.S. VtNN. INSTALLER 3 DESIGNER LIC. NO. MW /ayyP Se, 4425 3 0 7 /02, 70 'his test ~teAPPROVED y 5Tc~ r was fora convovonai s®pttc~systa.m~ , /oo , so i Srt r~,~ sv~ c(opy -'0 S, 5 E C T 6 7 P' ...rQ-C- !_,...U&.X +~n 51..-?)0 i l C E N 5 A ID iiors ~ Qom ay y8, ,C Qr o PPQ NW L _ r e3 wfl ) S ! Q I hl~ {o o o ~6 3 I~~ti~~s ~ J ,f, ~I?.,rte S-F~ 4ft f_ dS" I o' 3 UPnF'o~r i. d IoOJ f1`J/r" D Y) _ •~'7 0) f FRESH All' INLETS AND OBSERVATION PIKE C1,03S SECTION Approved Vent Cap Minimum 12" Above to3 3 U M 1 4t' Cast Iron Above Pip Vent Pipe To Final Grade. C' ' Marsh clay Or -Synthetic Covering Min. 2" A9J c rey';t( Over Pipe Distribution -Tee o4a e a l$ 0 Pipe lei "ddC ~~4 Perforated Pipe [}ego.: Aggregate e N _ r 1'' l 'bo,SC ~lleneath Pipe ct ---Coup)ing Ter.minat:.ra 5 Bottom of System REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 12/03/92-09:17 REQUESTS FOR INSPECTION WORK SHEETS FOR: 12/ 3/92 AREA: MJ - Activity: A9200413 12/ 3/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON, 10.29.19,NE,NE,LOT 7, SCOTT RD. Parcel: - - - Occ: Use: bescription: 186529 Applicant: HALL, RICHARD Phone: Owner: HALL, RICHARD Phone: Contractor: BOUMEESTER, JIM Phone: 386-9020 Inspection Request Information..... Requestor: BOUMEESTER, JIM Phone: Req Time: 11:12 Comments: 11;06 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION