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Code EPARCE Attach complete site plan on paper no han 8 x tchesPlan must include, but not limited to vertical and horizontal r ce pnlnt ll) *n a of slope, scale or . # dimensio ned, north arrow, and locati istanpe tea.roadt aAPPLICANT INFORMATION-PL E INRM , N DATE i PROPERTY OWNER: PROPERTY LOCATION - GOVT. LOT Alk 1/4S~F 1/4,S T N,R ,E (or V PROPERTY OWNER':S MAILING DRESS LOT # BLOC # SUBD. NAME OR CSM # CITY STATE ZIP COD E PHONE NUMBER ❑CITY VIL GE MOWN NEAREST R0~Dj [ ] New Construction Use V] Residential / Number of bedrooms _ [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 4~2 gpd Recommended design loading rate bed, gpd/ft2__L.Y'- trench, gpd/ft2 Absorption area required IL2,5- bed, ft2 da trench, ft2 Maximum design loading rate bed, gpd/ft2_,itrench, gpd1ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS ❑ U CSI S ❑ U (@S ❑ U C&S ❑ U ❑ S ®U ❑ S [RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barxlary Roots GPD/ft in. Munsell Qu. Sz. C nt Color Gr. Sz. Sh. Bed Trench 6-7 4 5 Ground 3 elev. ft. - 7 Depth to limiting f>~~ Remarks: Boring # - 0 s 'mss ,G sa L L_-) 7 zao 45 Ground' - C elev. ft. Depth to limiting tor Remarks: CST Name:-Please Print Phone: _ Address: S' Signature: Date: _ CST Number: PROPERTYOWNER SOIL DESCRIPTION REPORT Pag%.~Z~of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft yyyin. Munsell Qu. Sz. Cot Color Gr. Sz. Sh. Bed Trench . . )Z2 ~Y- C-1/Z A, I /A 41 1041, Ground s w -j X elev. - s S 44Z Depth to limiting factor , y Remarks: Boring # tt . 4ti Ground elev. ft. Depth to limiting factor L Remarks: Boring # 4 Ground elev. ft. Depth to limiting factor Remarks: Boring # ~r.~ .v x•. v::'•: Ground elev. ft. I Depth to limiting factor Remarks: SBD-8330(8.05/92) I ' I i j ! I I , ~ I I I I i I 1 I I I - - I I I ! I I I I I I ~ ~ I I I ~ - I - - j I I - I I 7 _ ewl I I ilk l - T - -T i I I I 9 _ I /d J I 11 A7 I i r` . j j ~ I I I I I I f ~ i 1xi I I j f , i I I , I ~ I I ~ ~ I i I ! ~ ~ j l 1 I 1 I j t r- I I o I ~ I I T - I ' ! T I j ! i ' 1 I I i I I I • I ~ I ~ I I I ! I 1 i i ' I I ! ~ 1 I i ! ' 1 1 ' 4 7- j 1 i a i j ! I I I ! ! I , i j' ! I ~ ~ _ 1 I I r , , j j ITS- I i I I ~ - ~ -ter -Y-' , T - - -r--_., i - - - - I ® - _I I i - - - - r I I ~ j i I ` I I I i r ~ I I - I I I ' --1-- I f I I i ti i I ~ I I I I I ~ j i I I ~ I 1 --F ! j I 1 1 I I I, I ; I I ~ j I { I 1 I l I I I i 1 t , : I : 1 I I I I , I , j ' 1 1 ' I I I 1 I , I I I t i I 1 f I I 1 , j II I i I i I ! j- I I I I ~ I ~ i ~ I I I j I 1 I i i _ i I I I I I ' r I , I ~ 1 I I I i I I I r , I i ~ I I i ~ I ' I I I i I 1 _ I i~tr~~artr>~tr~cgffry 3 .31.17.468g ~~WW S LOT 1 County: Labor and Human Relations PRIVATEE'WAGE SYSTEM Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: G~NERAL INFORMATION 186537 Permit Ho►Aer's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: QLRQN. R Y H & CYNTHIA M STANTON CST BM E rev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 036-1007-20-000 TANK INFORMATION ELEVATION DATA A9200422 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet Vent ii to ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A rl Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syesatem TDH Ft oss Forcemain Length Dia. Fif 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 CHAMBER INFORMATION Type O Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header J 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: STANTON 3.31.17.46B,NW,SE, LOT 1 I Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION 7 DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY R_ STATE SAN TARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% X 11 inches in size. ❑ Check if r'Svisio to pre sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRO PE TY OWNER PROPERTY LOCATION Y4 Y4, S T , N, R 1 (Or PROPERTY OWNER'S MAILING DRESS LOT # BLOCK # r CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER A'M H/-Z, .7 3-4247 7 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned O VILLAGE WN OF: TAX NUMBERS' ❑ Public R 1 or 2 Fam. Dwelling-#of bedrooms PAR EL III. BUILDING USE: (If building type is public, check all that apply) _ /p67© 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4.0 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 X 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-ln-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 .A ch) ELEVATION s'Gs Feet 7Z - Feet VII. TANK CAPACITY Site in alions Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank L. K 7 -T Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installat' n of the onsite sewage system shown on the attached plans. Plumber' Name rint Plumb 's ' natu : (No S ps) MP/MPRSW No.: Business Phone Number: Plum s ddress treet, City, State, Zi Code . IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature $ tp~ g►_., Surcharge Fee) Approved I El Owner Given Initial f0 9 Adverse Determination 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. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new s 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 administratoCor 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. 111. 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% 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 11& 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 pormit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), then 1a 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 P-, u1i Ls~y"') Location of• propertyNU) 1/4 SE~ 1/4, Section 3 , T _N-R _W Township C, S+ 13, IU Mailing address _ S c1 3~ ~hr~ Q 1~ Address of site fpm o ofp (_1hTV E? L11 C13~7<L-A W 112 subdivision name i e S~'/y~~ _Lot no. other homes on property? _yes-- ~J._No Previous owner of property _ , l A A Vk tav- - S i &CI Total size of parcel -1 Ca Q Date parcel -was created Am01 k ` t9 'Are all corners and lot lines identifiable? =Yes No Is this property t)eing developed for (spec house)? Yes No Volume e2 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 & 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. 4 - , 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. . S e of applicant Co- pplicant Date of Signature Date of Signature ~CUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 42994 BOOK 79' rA.E X81 REGISTERS OFFICE Hilda Karlstad a single person St CROIX CO., WIS. teed. for Record this 8 t h d of Sept. A.D. 19 87 quit-claims to ..Jeffrey H_. Olson and Cynthia M. Olson, husband and wife as marital ro ert with 8:30 M. rights - of_--survivorship,---___-.--__ ti eoM ads the following described real estate in ._._St,---- rQ1X---------------------- County, State of Wisconsin: RETURN To Tax Parcel No : Part of Lot Three (3), of Certified Survey Map filed August 19, 1977, in Volume "2" of Certified Survey Maps, page 441, as Document No. 342477, being a part of the West Half of the Northwest Quarter of the Southeast Quarter (W} of NW$ of SEJ), Section Three (3), Township Thirty-one (31) North, Range Seventeen (17) West, described as follows: Com- mencing at the Northeast corner of said Lot Three (3); thence South 00° 24' 34" East, 657.77 feet along the East line of said Lot Three (3) to the Point of Beginning; thence continuing South 00° 24' 34" East, 657.77 feet to the Southeast corner of said Lot Three (3); thence South 890 55' 43" West, 330.33 feet to the Southwest corner of said Lot Three (3); thnce North 00° 21' 39" West, 657.605 to the Southeast corner of Lot Two (2) of said Certified Survey Map; thence North 89" 54' 02" East, 330.00 feet, more or less, to the Point of Beginning, r i This iS...nD.t.------- homestead property. (is) (is not) Dated this -------4th day of --------..-..September.................................. 19...8.7... - .--(SEAL) (SEAL) *Hilda Karlstad x . . ------.(SEAL) . .--------(SEAL.) * - - ` - - - AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. • St Croix---•-•------...County. authenticated this ...-....day of........................... 19...... Personally came before me this ..4t11------- day of Se tgmber----------------- 19...87. the above named Hilda Karlstad TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me nown to be the person who executed e-foreg g instrument and cknow d e the same. ~ THIS INSTRUMENT WAS DRAFTED BY g - - t~-- - . Reinstra, Van Dyk & Needham, S. C. Attorneys at Law * Ruth A. Johnson-----._--------------------- New--Rich-mo-nd-,..-Wisc©n-si-n-•---54.917- 0-127 Notary Public St-. Croi_x.......... County , Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: - ----------1._2/_23/_.9-0- 19 -Names of persons signing in any capacity should be typed or printed below their signatures. H.C.MillerCompany~ STATF. BAR OF WISCONSIN rn— w._ , 1".. C~w..l. AL. 1 4AA'! r. 7 S ll 3.3 3~121 4 V ?;477 CERTIFIED SURVEY MAP WI/2-NW 1/4.- SE 1/4- SEC. 3, T-31-N, R-17-W 2 I teD EXISTING 4 AUG a9ooKN w CENTER OF TOWN ROAD of beft6 SEC. 3 (IRON BAR) PK. N 89°-52=20" E 1 N 899 52-26Z E 658.44 j 8 L W 1/4 COR. 2639.5 X90 329.22' 1 I 329.22' SEC.3 I g NORTH LINE- (IRON BAR) SE 1/4-SEC.3 N 5~,I I Oo' I I I I I 1 LO 66' APPROVED 1 0 T 2 1 1 EASEMENT 4.98 A. 1 m i BEARINGS ARE AUG 17 1977 0 lrn i REFERENCED TO THE p 10 1 C0 WEST LINE OF THE c ` I I I SE 1/4 OF SEC. 3 p + ST. CROIX COU TY (ASSUMED BEARING- COMPREHENSIVE PARKS PLANNING N OO°- 18'- 47" W ) AND ZONING COMMIntE I WI N -4 LOT 3 WEST LINE- N89°-54'-02"E~ \i 9.95 A. m SE 1/4-SEC.3 329.77' 1\ R= 80 0 o in o A _ o N ' iA A W 200' 100'50' 0 20C LEGEND rn LOT 1 rn ' -4 4.98 A. ~ m 4 rn SCALE 1 m a 200' O- 1" x 24" IRON PIPE SET A o WT. 1.68 LBS. /LIN. FT. ego 119; ~O 330.33' 330.33' GENe c. T SHAFFER S 890-55'-43"W 660.66 S-125 I HUDSON „ THIS INSTRUMENT DRAFTED BY WIS. e. Q- : G.C. Shaffer .to 0 `I y0 us R~~~~ JOB No. 7 7. 1 4 I~~~//IIIt~N~,, SEE REVERSE SIDE FOR CERTIFICATION Vol. 2 Page 141_ APPROVAL Of THIS MINOR SUBDIVISIC;t~ Certified Survey Maps DOES NOT MEAN APPROVAL FOR St. Croix County, Wis. BUILDING SITE OR SEPTIC ; Y T M. REFER TO H62 0. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS (~L)e FIRE NUMHER__ I] CITY/STATE Ge P, S ZIP-_ 'S 40 I PROPERTY LOCCATION : ~l•~l/4 ,~1/4 , SECTION 3-J, T 3 I N-R_,_J_W TOWN OF_ J~~sW jYv , St. Croix County, SUB vlsfo~ tW'/z J >`i( \04 A. SE %y Sic `°r~ 3 , LOT NUMBER_I_. 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. S Croix County residents may be eligible to receive a grant for a maximum of 60% 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiratio ate. SIGNED: DATE : I ! '7 Z St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L of Labor and -ian Relations Divlsilsn ofety a Buildings in accord with ILHR 83.05, Wis. Adm. Code _ Cl 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 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 1~~ Z~~- ~ OWNER: PROPERTY LOCATION GOVT. LOT A1jj 1/4s 1/4,S T N,R 40r 1 PROPERTY OWNER':S MAILING DRESS LOT # BLOC # SUBD. NAME OR CSM # CITY STATE ZIP C DE PHONE NUMBER ❑CITY I LLAGE MOWN NEAREST ROAD, [ ] New Construction Use Residential ! Number of bedrooms [ Addition to existing building DC] 1 Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate _ -bed, gpd/ft2- trench, gpd/ft2 Absorption area required /J,?S" bed, ft2 e6 trench, ft2 Maximum design loading rate ~ _bed, gpd/ft2 =trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ 7 ft (as referred to site plan benchmark) Additional design / site con id/erations Parent material ~,Z'c e2j ti«w Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem OS ❑ U 7 S ❑ U MS ❑ U [AS ❑ U ❑ S O U ❑ S 0 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. 22nt. Color Texture Gr. Sz. Sh. Consistence Bourtciary Roots Bed Trench 0-7 /jQ 1114 >X., ~~zfikx`z?~S 7-,17 A!f) 1V _'V14 Ground u nd - -Y , S l - - 7 ft. Depth to limiting fact L 4 Remarks: Boring # Z' 51t _9 7 Ground - elev. ft. Depth to limiting factor y Remarks: T Name: Please Print J Phone: Address: Signature: j ✓ j / Date: _ CST Number: PROPEMOWNER J r~_ ~~ntiJ SOIL DESCRIPTION REPORT Page, of 3 PARCEL I.D. ! Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. Bed Trench - •~S L -9-17 A9 Al 6- Ground elev. 44Z i 8 Depth to limiting factor , y 17 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SED-8330(8.05/92) l~li ,_~-III I III IIIIIl~! T I I I , slt01.4 WS AL ~vg - , w"V, I ~ - - - - --i - t -411 i 1 i l I I I( ► 1 ~ ~ I ! 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A Ovw ►a• fire T►• • $••••1• Ilpe ►wlwu•• Pipe YN•v • -lw«I••11•9 A• p us ~ /•/1•w 01 iI.1•wPro c D fins-1 ra cl c ot~ SOIL FILL' 013TKIBUTIOI.1 PIPC • AP►RO`/CG SyNr1cTIC cove rOFAGGREGA?E"'"'MATZRIA. OK 1' OF STitAM OR MARs1. ►;A,y ELEV. OF2L7FEET-.. •~L'b4' (."OPYt'Tt-A GRC GATC ~ , .•r\~ ivy. OISTRIOUYION PIPC TO pE AT LCAtT IWCNCS 8CLOW ORMIWAI. 1:1440C AUU AT LEAST LO IWCHCL BUT 1.10 MOIIC THAW 42 IMC11f S DCLOW f%NAL, relkAOC MiUgM t% DEPTH.OF EXCAVATIOP FROM Mibwu 6RAvE WILL, BE IIJCHCS 1NNlr m ©crnj OF EXCAVATION r1~0^ OR,I4114AL GRAPL WILL et INCHCS 'r SIGWCO: "LIG C U SC t1UM8C It: S` ~ t^ i • OAT E : - REPT131 STANTON ST. CROIX COUNTY ZONING PAGE 1 12/10/92 10:43 REQUESTS FOR INSPECTION WORK SHEETS FOR: 12/10/92 AREA: TN Activity: A9200422 12/10/92 Type: CONVSEPT Status: PENDING Constr: Address: STANTON 3.31.17.46B,NW,SE, LOT 1 ' Parcel: 036-1007-20-000 Occ: Use: Description: 186537 Applicant: OLSON, JEFFREY H & CYNTHIA M Phone: Owner: OLSON, JEFFREY H & CYNTHIA M Phone: Contractor: O'CONNELL, KIM A. Phone: Inspection Request Information..... Requestor: O'CONNELL, KIM Phone: Req Time: 16:12 Comments: Alf, Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION ~3~/ / s 3'ds5 ~}c 1 \ f w 7.Sc t o y 0 C ti 13 d -1 3 ~D to ~ ~ eD ~ ee v A~ • T m I A d cn z-i z O OI zm z OI cn00 ~ C4 W -4 a m z y? m a CD C,) 0 y cn O m o 5 C- CD W 7 C- ° O ? CD J N 0 m I N v p N co co :3 m 5M c ro n I W b m 0 Cn (D CD CL O CL O O y N-4 I H O p c cc l O C U) CA vDi o 4 N m y a s cwn D N W o y W a I~ o D I a O c 3 p N m l O ° w m o v N v CD W CD z co CD z co r- CO) 0 co c.0 N I cc ~ N- C lY D) I 01 CD Z Z 000 ~I 000 h• i o t I N Q C y A O Ion ~ 3 to CO) 0 3 CO) m vi o0 i _ D ~1 N° 0 7 m CCD O V I c~ V N CD fn '0 _0 3 - N a ~ I o K 0 I O D 0 o I D m 0 V a O a N =r Err !V cn in • m m ~ (~pp N y (D N ~ N C CD c 7. I CD (G N - ~I N ~ C CD CD ~p C, a I a EL 3 5 3 z = cn = (6 A N o y cc 0 a I a 0 I Z -i w A W T CL I c z ~ m I I W v I w F it ~ ~ I s D 3 CD v, 0 D 3 N n I m 0 =r 0 a B o I ~__3 a o 5D 99 S .Co 0 3 o m c 5 = v c y 0 a C,) a) oy 0 a m CD cn ; I a n y m a > > -m a CCD DO I yv,3 8 D a V C O'D CO CL (D O 7. C I ~ 7 0 ' 0=1 G) I y 0 -0 CD~ I yNa qtr. ? I a x ° vtNv O CL Fit w M CD m N fD CL O CL m a ° :E• C w ti o 0 b tv o cD I m A to O I c ~o O ~ ~r p b 6 0 i. I °o i _ A.__..___•. _ - AS BUILT SANITARY SYSTEM REPORT i ;ER TOLINSHIP „ SEC.M TjN, R_ 7 j. ADDRESS , ST. CROIX COUNTY, WISCONSIN. . IDIVISION_ LOT ~ LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .I j I I ~ i I j a I I ~ x~ ew i I i-Ti 'TIC TANK(S) MFGR. Indicate No,%th Annow COPCRETEds __k" STEEL Scate 1'' yD NO. of rings on cover` Depth DRY WELL -"NCHES NO. of - width length area no. of lines width" length 3F F_7 area dept to top of pipe 3:2CATE 3 ~ w: RATE AREA REQUIRED 1 /,,)AREA AS BUILT ,claimer: The inspection of this system by St. Croix County does not imply complete .,xpliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for rtem operation. However, if failure is noted the County will make every effort to ..:ermine cause of failure. -a►SES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. '-INSPECTOR DATED /o -17- 7, • PLUIMER ON JOB (~~r1r1 .i !-nwa.es LICENSE MfBER r,~r 3 t REPORT OF ITISPECTIO?1--INDIJIDUAL SE1,1AGE DISPOSAL. SYSTEM . Sanitary Permit _51 • - r State Septic IE TOWNSHIP t. Croi;. County SEPTIC TANK M • :size gallons. `umber of Compartments Distance From: Well ft. 12% or greater slope £t Building' ft. Wetlands f: I1i0niater ft. DISPOSAL SYSTEM Tile Field or Seepage Pit(s) Distance From: We 11. ft. 12%.or greater slope* ft Building ft. Wetlands f FIELD Hiphwater ft. Total length of lines ft• Number of lines Length of each line ft. Distance between lines ft. Width of the trench `ft. Total absorption area sq. ft. Depth of rock below the in. Dp-pth of rock over tile in. Cover -nver.rock., Depth of tile below grade in. Slope of trench in Der 100 ft. Depth to Bedrock ft. Depth to ground water ft. PITS . Number of pits Outside diameter ft. Depth below inlet ft. Gravel around -pit: __yes no. Total absorption area _ sq. ft. Square feet of seepage trench bottom area required :square feet of seepage nit area required Inspected by: Title': . Approved Date 197 Rejected Date 197 t Y -A d r 7 4 .77 f .f - yf~ •gy~- ~ f ~l i'.,a ~ ate,,.. 0; lot r o w ; pt- n , 4;z 77 e y wa v • I lye f v - •.5 t~ s. .x i ahl0 arm, J, 5* r ~n'~ A 141_ 'K # i 4 ~p#~f~, ~ ~'~rt~ #1'►~ ~ ~ ~ yv~ ~ a#:~td firth=. a~ t - fir- ~ - T 77. p H ~ a 7 xor 1 l *;4 r rirtI . Y arc k wa4 9`rx.YA ~..i - 4611, .w. 47 y X 41 as i t-~ 51~ a i r p { 1 . • _ .;:a;J.c . , a a. . "~w.._ : ~ L .,.r~F ..._,~._.s,•... , :c.. J._+.~~ a ~-4~1~II.,.si. rx_r. ~t,~_„ n... yer~.i.~.:r. ~f,. da,+,.~k.i,r:id.~ J PLB 6 7 State and County State Permit Permit Application County Per # ! for Private Domestic Sewage Systems County 0 *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY R n Mailing Address: ~~vtCtchr►tichc~ W~SC, SSzD~ 7 '4 (a, B. LOCATION: YES Section 3,__, T 3 N, R~ (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~~fQ N~o /L C. TYPE F OCCUPANCY: Co mercial *Industrial *Other (specify) *Variance Single family_ Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY lt-00 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate _ Total Absorb Area sq. ft. NewxReplacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)_ No. of Trenches Seepage Bed: ' X Length 52 Width ( D Depth Z:70" Tile depth (top) YV No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land ~ 02n Distance from critical slope - WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on H 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, i NAME Dl1 C.S.T. # Jc y E', and other information obtained from r (owner/builder). Plumber's Signature t✓ v- MP/MPRSW# J5 4:,-3 Phone #o24/&- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. II t _ U ' E e e _ i ,.M L 3 E E i LAY Do Not Write in Spa Below - OR COUNTY AND STATE DEPARTMENT USE _ONLY Date of Application Fees Paid: State ,&190 un y Date oZ~ ~7 Permit Issued/Baisesed- (date) a-2--a-79" _Issuing Agent Name Inspection YesNo State Valid# Date Recd 1. county (vv 4e copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 ,N,RJ_Z~ (or) W, Township or Municipality ~~y~✓r/~~~ LOCATION Section - T~ C,.'!`~~ ✓ Lot No. , Block No. County ST Owner'sBuyers Name- Subdivision Name Mailing Address: ` rI ALL TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW, REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS ?-/3- 79' PERCOLATION TEST,ryS~~i~' jg SOIL MAP SHEET NAME OF SOIL MAP UNIT <<- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- * 'n A P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 2Y. S.4 B- B- - - B- B- JB- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. t , # A /?'~,4/~ 41 r 3 N . . E 1 3 y 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Certification No. Address ' r Name of installer if known Copy A -Local Authority CST Signature ,P LB State and County L4,- ~,v¢(,r~r! Permit # 1, Permit Application County Per # ~J ri ate Domestic Sewage Systems County *DENOTES STATE APPROVAL R UIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 7~'; ' '1~Z4 /~d 7~.~ist pct 4✓~-19 B. LOCATION: .41jZ_'/. --,SZ , Section -3 1 Tml~ N, RZ-~7 f (or) _W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township aST_rw C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms? No. of Persons D. SEPTIC TANK CAPACITY 146,0 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concretePoured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate yZ-Total Absorb Area sq. ft. New, ~X_Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: -4_Length _Width4.2 ~ Depth 1961 /0, Tile depth (top L No. of Lines cm;;? Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soi, Tester, NAME ,~.rttilly 7`,~.•'~ -Z(" C.S.T. # and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# AS l-~Z Phone 01a &W-4a 4g.;j- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. a 3 . e ; L 3 i F E . E E E Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE NLY n L Date of Application - - Fees Paid: StatefC), e>e~ Co Date - Permit Issued/Re i' (date) 3 - Z~-Issuing Agent Name G Inspection Yes No State Valid* Date Recd 1. county (wh' copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78