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AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP/ 37
OWNER _J cl V
SECTION T N~~-R W
ADDRESS / 7,'-/) CROIX COUNTY, WISCONSIN
' 17
SUBDIVISION Xe i 1-" n Z LOT ~ LOT SIZE
933 1 °``i pL vlEw . 2. Z~. 3l . I g. 't°I
M
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM )z
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INDICATE NORTH ARROW
BENCHMARK: Elevation and description: 46-7e, T/l' 5' Ve i 1LT---
Alternate benchmark ~ ,CO
SEPTIC TANY:Manufacturer: ` Liquid Cap. o~
Rings used, Manhole cover elev:``,2LFinal grade elev:
Tank inlet elev.:- Tank outlet elev.:- ~
No. of feet from nearest road : Front_~, Side_ Rear Ft .
From nearest prop. line:Front , Side., Rc,~:ar Ft. /
No. of feett from: Well 6 , Building A
(Include this information in the above plot ;:clan)
(2 ref ererrce 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
SOIL ABSORPTION SYSTEM
Bed: Trench:- 1v- Seepage Pit:
Width:- 4-L Length 29 r Number of Lines: Area Built
Exist. Grade Elev. lir . Proposed Final Grade Elev. l°
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side, Rear Ft~ 7
I
No. feet from well: 7$ No. feet from building 7
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:
INSPECTOR
DATE : PLUMBER ON JOB : x /rzi
LICENSE NUMBER: l`
6/90:cj
TLab,Qr 28.31P~•I XWSrMAW Y~EM 104TH S County:
Safet and Human Relations INSPECTION REPORT
Safety and 6r;ldings Division ST. CROIX
(ATTACH TO PERMIT) San ita ry Pe rm it No.:
GENERAL INFORMATION 186541
Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.:
STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
60 d0. 66 0-5 0611 038-1166-20-000
TANK INFORMATION ELEVATION DATA 9 0429
TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV.
Septic C Benchmark .S/Oi J (,8
,
Do
Aeration Bldg. Sewer , 77 9215,2
Holding St/ 14 Inlet .3 cylS~
TANK SETBACK INFORMATION St/ Outlet
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic y~ cR,~ 'n r NA Dt Bottom
Dosing NA Header kMvm. '7W
Aeration NA Dist. Pipe z
Holding Bot. System g, 35 r
PUMP/ SIPHON INFORMATION Final Grade 7, 7 , 33
Manufac Demand
Model Number GPM
TDH Lift Friction System Ft
Fie
Forcemain Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width , 1 -7.3 1 Length i No- Of T enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /02 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type of CHAMBER
CH model Number:
System: UNIT
p~ 6a ~GCJ
DISTRIBUTION SYSTEM
Header /d Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake
Length 9 Dia. Length __X_ Dia. Spacing 6
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 /_T4Qoth Center y Bed/ 1=~h Edges 30 -die Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRARIE 28.31.18.794,NE,SW,LOT 2 104TH ST.
Plan revision required? ❑ Yes No I A r~-~
Use other side for additional information. vb~ ,
SBD 6710 (R 05/91) Date 2_,Inspector's Signatu a Cert . No.
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
P&HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
ST SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~Q~ !n c!
8% x 11 inches in size. ❑ crldblt If`f~vls o pri ions application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY O NEi PROPERTY LOCATION
j a l- A '/4 k,~%4, S ;Z-12r T3/1, N, R E (O 6AV
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
AI
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
er o~ < 3 ~l h @ -5 f f~
11. TYPE OF BUILDING: (Check one CITY ~ NEAREST ROAD
) State Owned ❑ VILLAGE ~ fur A ~ r, /C>
❑ Public 01 or 2 Fam. Dwelling- # of bedrooms R EL A NUM R(S) c1
III. BUILDING USE: (If building type is public, check all that apply) Q 3 v G 6-
I
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)
El Reconnection of 5. ❑ Repair of an
A) 1. New 2. El Replacement 3. El Replacement of 4.
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 9 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
(,9 t~ 5 7 g ~j , , Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank -K+ - ~T F1 El 0 1 0 El
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): i Plumber' Signature: (No Stamp MP/MPRSW No.: Business Phone Number:
"Z
Plum r dress (Street, City, State- Zip Code):
do
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Iss ' Agent Signat Stamps)
Approved El Owner Given initial Surcharge Fee)
Adverse Determination tk6 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 sanitgr' y. permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending cn 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 3% 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; close 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)
APPLICATIOH FOR SANITARY PERMIT
8TC-100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. My inadequacies will only result In delays of
the pzrmlt issuance. -Should tfilo development be intended for resale by
ovnet/contractot,(spec houa0 p then a second form should be retained and
completed when the property is told and submitted to this office with the
appropriate de4td recording.
Ownet of.propetty ./G-~/~ L
Location of property jC_-111 P✓ /4• Sectlon _ e-
Tovnshlp
Mailing address ~C-p- 15.1
/V 4 .ass. A/l...~ ~'iG,s/rsc•~1.~ s.!/ ~Yo~~
Address of jktX)e
•ubdlvlslon name, ~=El~/DES ~5~~ES .~~01" z
Lot number
Previous owner of property Ch0il5-E>o~->
Total size of parcel _ Z
Date parcel was created
Are all corners and lot lines Identifiable? ,.Yes No
Is this property being developed for resale (spec house)? as No
Volume and Page Number -5f as recorded with the Register of Deeds.
- - - - - - - - - - - - - a - - - - - - - - - - - - - - - - - - - -
INCLUDE WITH THIS APPLICATION THE FOLLOWINCt
A WARRANTY DRID which Includes a DdCUH=NT NVMB%R, VOLUMR AND PADS xLymaLR, and
the 89AL OF THE R8aIBUR OF DIdbB. In addition, a certified survey, if
8v.allable, would be helpful so as to avoid delays of the reviewing process. It
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 an this form ate true to the best of my (out)
knovledgel that I (we) am (are) the owner(s) of the property described In
this Intotmatlon form, by virtue of a warranty deed recor dad in the office of
the County Register: of Deeds as Document No. Q Z 3PY I and that I (We)
ptesentiy own the proposed alto for the sewage disposal system (or I (we) have
obtained an easement, to tun with the above described property, for the
construction of s id system and the same has been duly recorded in the office
of the ynt lots adss as Document No.
signature o vnec Signature of Co-owner (If Applicable)
Me of Signature '
Date of Signature
i . J- 1U . -iJ V 1 1J J~ U 2U-
DOCUMENT NO. WARRANTY DEED THIS SPACE nESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
* WS W ICE
Richard J. Wipr~ ~Y1/~ j}~ ~~e M pr h~ ~Cband ~Y1 wa.fe
.............................Y-t._5£t.'CSt..~r!:I:4~i!l.-_.._l...Y:s'sY..-3-_-. }":Y.._...._..!?t: CMX CO.! 1
Rv Record
conveys and warrants to moll el. ji.-_ aS'~Tk'l._S D~ 17 2
3 i 15 5 P.M
consti 1dtion............................................ - nn
~A
RpUhrofDpds
RETURN TO
.
the following described real estate in ..t • CrO - ....County,
State of Wisconsin:
Tax Parcel No:..............................
Lot 2, Red Pine Estates in the Town of Star Prairie, St. Croix County, Wisconsin.
FIB
This IS. t?dt_........ homestead property.
(is) (is not)
n to . -easements- restrictions- and-rights-of-way- ~ of record--'-if
. _ Exceptio warfa3l'"ties:: ~ anY~•~-•
Dated this Q V day of ------....DeQ .119-921...
.......................••------------•-.......------•-----.....----.(SEAL) (SEAL)
J. Wi
.............---._......................................_.-•---......(SEAL) (SEAL)
Diane M. Wier
AUTHENTICATION ACKNOWLEDGMENT
• A! ~dNJE~77t
Signature I's) STATE OF 2CCUUMbObigo
ss.
. County.
authenticated this day of 19.-... Personally came before me this .Y±......... day of
- ---A.64•.#1!!6-0t 19px.'.'.'. the above named
..._...l.~le.-MA&V .5;.................................
1#•
s
TITLE: MEMBER STATE BAR OF WISCONSIN
--z t - - -
-
authorized by § 706.08. Wia. State) to me known to be the person i----------- who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS ORAi:TRD BY `
1"gamsi a.
Attorney at law
' No y Public - . County,
(Signatures may be authenticated or acknowledged. Both M Commission is permanent., f not, state expiration
are not necessary.). date: _
_..:3.. :ff 2 19.'_q"f...7)
- -----1--- - . _ - - - - ~s;~ -
.Names of persons altulns in any capacity should be typed or printed below their sisnaturs. - ~eect~LY
?Nr~s/s#YPLOW -tom
j, WARRANTY DEED STATE BAR OF WISCONSIN I C Inc.
FORM No. 11- 1982 - '
1. !Ulq
0
"A Peaceful Rural Subdivision"
" r
~r,..
team 1 realty
i Dave Bracht
Jim Moe
(715) 247-5900
ro (715) 246-7125
*20% Down Terms Available *Wildlife
*Building Contractors Welcome *Near Apple River
*Electrical & Telephone Installed *No Assessments
*Township Roads *Somerset Schools
Lot #
1. 3.5 ac. $14,500 6. 4.9 ac. SOLD 11. 3.3 ac. $19,000
2. 3.2 ac. $14,500 7. 2.5 ac. $12,500 12. 2.2 ac. $16,000
3. 3.9 ac. $15,900 8. 2.5 ac. $12,000 13. 2 ac. $14,000
4. 2.4 ac. $13,500 9. 8.1 ac. SOLD 14. 2.1 ac. $16,500
5. 3.1 ac. $14,900 10. 5.6 ac. $19,500 15. 2 ac. $19,000
16. 2.9 ac. SOLD 21.6 ac. SOLD
17. 2.4 ac. SOLD 22. 3.7 ac. $18,000
18. 1.4 ac. $20,000 23. 1.62 ac. $16,500
19. 2.4 ac. SOLD 24. 2.1 ac. $16,500
20. 3.3 ac. SOLD 25. 1.9 ac. $18,000
eso s4o 4
1 I I 10
15 14
16 807 606 13 I 803 802
R S"D 605 4
" 17
S(9LeD 4 -NW 4 23 I 114 - NW v4 8
rs,a / 615 8 4 601 8
~.a ' \ . 800 s
/ 4
816
b So 87 SOLD
Ilk,
f
t N• 22 400• 70R 10•
614
0
SOLD
19 I I
_ I
811 20 81I3
$ 812 SOLD
QLD I 47a e
111
,S 65
~ar~raq _ ~=~-s-•:. ,C.d.i ~ 10 356$2' 37110
Hsi e SOLD
ton 7
799 3
" • Sta Prair;f , 798 °
~I 795
M E E T 4 8 5
Johannesbur I i
w rii t ao VP A I R I E` 794
_ K 5 u~--
z 797 I`
c A Somerset ` Richmond 4
796 I 793
N `II IDS • ;1.: 't I ( ~r~ ~1 "
4' I
C . S. M. VOL. , PAGE 1 15
MON 10 SO.
5 B
Bp ~ .I SOH $ sdL~
LO I LOT 2 LOT 3 LOT
I .4
J
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SEPTIC TANK MAINTENANCE AGREEIIENT CU
St. Croix County Fa
w
OWNER/ BUYER / f eE S µ
0
ROUTEA90X NUMBER Z~ Fire Number o
CITY/ STATE ZIP 1 y~ Z
w
PROPERTY LOCATIONf.,5,E k,S jJk, Section Zif • T3 / N, R /8 W,
. I
Town of /''/s►•t1E St. Croix County,
Subdivisions , Lot number__
Improper use and maintenance of your septic system could result in
its premature failure.to'-handle wastes.'-Proper maintenance con-
sists of pumping our We sepCie tank every three years or sooner,
if needed, by a licensed 'se t'ip. tumk umer_. What you put into
-the system can affect the function---of ' the 'sceptic .tank as a treat-
meet'staga in the waste disposal systei.
.
St. Croix County residents- Ma**be eligible to recieve a grant for
a maximum of 607. of the•cost.of replacement of a failing system,
wh c'`was in 'operation prior to-.July 1, 1978. St. Croix County
acceP ted-,this program in August of 1980, with the requirement that
owners of all* new 's' s 'ems agree to keep their system properly
maintained.
The property owner agrees t• submit to St.. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or..a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2).after inspection 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.
H
I/WE,-the undersigned have read the above requirements and agree 0
to maintain the private sewage disposal system in accordance with N
the standards set forth, herein, as..set by the Wisconsin Depart- ar
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix Coun=oning within 30 aye
of the three year expiration.date.
SIGNEDDATE
St. Croix.County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and Human-Relations
Division of Safety 8 Buikfings in accord with ILHR 83.05, Ws. Adm. Code
COUNTY
Attadt co8tplete site plan on paper not less.than 81/2 x 11 inches in size. Plan must include, but J
a : PARCEL I.D. #
and-fionio " . reference point (p".,drectto~ acid % of slope, scale or
*r o -affow, and4ocatiory-aM-c istance to nearest-road-.-
AOPt-4ekNTINFORMATiON.6aPLE-ASE PRINT ALL INFORMATION IEWED BY DATE
r
PR0f;Z f R PROPERTY LOCATION
f~GOVT. LOT 114 1/4,S T N,R _qj ONVNERMAID ADDRESS LOT LOC # SUB NAME OR CSM #
ZIP CObE PHONE Wl]MBER ILLAG OWN NEAREST
p~ New Coistruction Use b4 Residential / Number of bedrooms [ J Addition to ebs*v building
i l Replawnent [ ] Public or cormnercia l describe
Code derived daily flow Z46_ gpd Recommended design loading rate -,gybed, gpo1R2 a trench, gpol(12
Jlbsorpdon area required ASS W R2 X!(Z trench, ft2 Maximum design loading rate bed, 9Pdlft2~~trench, gPdlft2
ftwd >lended irtliliadion surWe elevation(s) Z Z R (as referred ID site plan benchmark)
Additional deW
Parentmffier"IF - Flood n elevation, N applicable ft
MD U a 1' ; , j r Hon( NA D NoROmPRESSURE AT-GRADE SVSTM.N FU HOLDING TANK
for" `~s': ®s E3 u ®'s ❑ U ®s ❑ u ❑ s rru ❑ s oil
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture . Structure Consiskince Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch
0-J5- s-
Ground 3 /-4 1A C1'e '/V s r 6do- a A,
elev. ej
Depth to
limiting
WIN
Remarks:
Boring #
7
Ground 3 -
elev
Depth to 151- -
limiting _
facts
>
Remarks:
T Name.-Please Print Phone:
ress:
Sgnature: ✓ i Date: _ CST Number .
PROPERTY.OWNER.„ ,J SOIL DESCRIPTION REPORT Page,.2 -of
PARCEL I.D. #
Boring # Horizon 'Depth Dominant Color Mottles Structure GPD/ft
Texture Consistence Boundary Roots
Troft
- "
:
in. M46411 Qu: Szont Cobr ?Gr. Sz: Sh Bed
3 ~ ~I
-2 %,w z-At' Az 14 ti a2L- 4e.
2raw.
b
Remarks:
Boring #
.12 G.
Jv
Ground f
elev.
Depth to 44
limiting
factor
? 9~
Remarks:
Boring #
131
Ground 94 -?19 X5
"
elev.
f
Depth to
limiting
fac
Remarks:
Boring #
[3:
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05P92)
T I l l l 1 1:, 119 I
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PLOT PLAN
PROJECT ADDRESS Z~ d~ S-
1/4 ,5i,~) 1/4/Sa4/T .3/ N/R /4W TOWN COUNTY
MPRS Byron Bird Jr. 3318 DATE "2-- -
BEDROOM_f CLASS PERC~_ CONVENTIONALZ4N-GROUN RESSURE
CONVENTIONAL LIFT_ MOUND_ HOLD G TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA - PERC RATE BED SIZE 2-2-
1L Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark ion >i fe~5~~ ~c
* H.R.P. J`~_ Cor~tr o ~a 4~
0 Borehole Q Well Scale = Feet
0 Perc Hole System Elevation
Uent
12"
Grade
TYPAR COVERING
12" 3- 4 6- O 3- 3 - Bwv~
Sewer Rock
6"
-
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REPTa31 STAR PRAIRIE ST. CROIX COUNTY ZONING PAGE 1
04/21/93 12:05 REQUESTS FOR INSPECTION WORK SHEETS FOR: 4/22/93 AREA: JT
Activity: A9200429 4/22/93 Type: CONVSEPT Status: PENDING Constr:
Address: STAR PRARIE 28.31.18.794,NE,SW,LOT 2, 104TH ST.
Parcel: 038-1166-20-000 Occ: Use:
Description: 186541
Applicant: HARTMAN, MIKE Phone:
Owner: HARTMAN, MIKE Phone:
Contractor: BIRD, BYRON JR. Phone: 268-7616
Inspection Request Information.....
Requestor: BIRD, BYRON JR. Phone:
Req Time: 13:04 Comments: 11196
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
r-
V*%coitsin Department of Industry, S T E EVALUATION REPORT Page L of
,kal~oPand Human Relations
Division df Safety & Buildings
~ In acc HR 83.05, Wis. Adm. Code
~ COUNTY
Attach complete site plan on pap I4s than 8 Y2 inc i size. Plan must include, but
not limited to vertical and horizo r fer:#r%e poiAt (BKW- ecti d % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and I cation ddWan` e to 'Zi
st r
APPLICANT INFORMATION, -'PRINT A4t NF4 TION REVIEWED BY DATE
PROPERTY WNER: PROPERTY LOCATION
GOVT. LOT 1/4 5-41 1/41T N,R J~(or l
PROP TY OWNER':S MAILING ADDRESS t. LOT # BLOC # SUB NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER CITY VILLAG OWN NEAREST 0 D
Jr ( ,
[~(J New Construction Use ~Q Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate ed, gpd/ft2 trench, gpd/ft2
Absorption area required 7 bed, ft2 trench ft2 Maximum design loading rate ~ -bed, gpd/0_.~trench, gpd/112
Recommended infiltration surface elevation(s) 9 / It (as referred to site plan benchmark)
Additional design / Sy e con iderations
Parent material - Flood lain elevation, if applicable It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem 0S ❑U 2S ❑U US ❑U OS ❑U ❑S 12 ❑S ®U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
10
7
•ii ::.J::: n•
4v nvv.....uv.vv,
Ground s r w
elev.
fitl ft. - ,
Depth to g-)L P6 '1A s -
limiting
factor
Remarks:
Boring #
40 qZ 1,4
Ground 3
elev / 1W "41 Z", &A~ #Y a Li _/d
~ft. r
Depth to - s
limiting _
factor
> Z/
Remarks:
CST Name: Please Print Phone:
Address: /
Signature: I Date: - CST Number:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page,.;?.of_,jZ_,
s
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
o
4-1-9 A0
Ground _
eley.
Depth to
limiting
fact
7
Remarks:
Boring #
A/ A
Ground -
elev.
ft.
Depth to 's
limiting
factor
Remarks:
Boring #
M
_h2 Y
Ground
elev. /
ft.
Depth to _
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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