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AS BUILT SANITARY SYSTEM REPORT
i
OWNER Lk A-L ! LK &(14 A'?! 6~rOWNSHIP d
SECTION--,?,6 T K-U N-R-2W
ADDRESS L~ oX ST. CROIX COUNTY, WISCONSIN
SUBDIVISION dAk ~ CE 6Cc"-' S LOT LOT SIZE Lo
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
d~o2~o t>g '0 -21 -
L5 1Y)
J
v you
17- 6 igx 6~ _ b~
w t L~ M
Z' A INDICATE NORTH ARROW
BENCHMARK: Elevation and descr piioon: 70-1P 6~vt~ v 0 u ~L~TY Bak
Alternate benchmark ~E dO A$-f 6t" I4 1- C
SEPTIC TANK: Manuf acturer : lit/ 51~7-/t5 Liquid Cap.
Rings used:f-Manhole cover elev:5'inal grade elev: 257
Tank inlet elev.:-V, 4(` Tank outlet elev.: qZ. 23
No. of feet from nearest road:Front✓; Side ,Rear Ft.
From nearest prop. line:Front2~; Side , Rear Ft.
i
No. of feet from: Well , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
{
PUMP C ER
Manufact r r: Liquid Capacity:
Pump Mo 1: Pump/Siphon Manufact.: Pump Size
Elevati n f inlet: Bottom of tank elevation
Pump o~ el 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: Seepage Pit:
Width: Length Number of Lines: Area Built,.ILV
Exist. Grade Elev. 222 Proposed Fi al Grade Elev.
Fill depth to top of pipe: c;
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from well:,A) No. feet from building /
HOLDING TANK
Manufactu r: Capacity:
No. of rin used: Elevation of bottom tank:
Elevation inlet:
No. feet rom nearest prop. line:Front , Side , Rear Ft.
No. feet rom: Well , building , nearest road
Alarm Manufact rer:
INSPECTOR:
DATE: PLUMBER ON JOB: /
LICENSE NUMBER: M~ S,7/
6/90:cj
1A
Wr att1TR9fXrAs4~,28.19.819P&A'j,5rWjGj'S'Y MVRIDGE D County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 180302
Permit Holder's Name: ❑ City ❑ Village ❑yown of: State Plan ID No.:
WT TROY
BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
Od, w O 040-1188-90-
TANK INFORMATION ELEVATION DATA A9200383
D 9Z
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
d Benchmark
gtz
Do
Aeration Bldg. Sewer / Z.
Holding St/?(t Inlet
TANK SETBACK INFORMATION St/ Outlet Z3t
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt nlet
rl
Septic Zo#,2 NA Dt B
Do' NA Header h
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade 13, 2,3t
Nlanu!act ur Demand ' 7` f 79
luj(s° CG
Model Number GPM
TDH Lift Friction tem TDH Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length r No. Of Trenches IT NQ-Qf Pits Inside Dia. Liquid Depth
DIMENSION ,~3 D
S 11F I I N
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI Manufacturer:
SETBACK
INFORMATION Type O i CHAMBER odeI Number:
System: IA
OR UNIT
DISTRIBUTION SYSTEM
Header / a4icif,11 ! v Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length j V Dia. Length _&O Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over rLn n xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes El No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 36.28.19.819,NW,NW, LOT 66, WOODRIDGE DR.
4, j
40
Plan revision required? ❑ Yes o
Use.other side for additional information. /Z
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No.
ADDITIONAL COMMENTS AND SKETCH
u Y
SANITARY PERMIT NUMBER: F r
SANITARY PERMIT APPLICATION
:ZDILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ A 8% x 11 inches in size. prev iou
s 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 AL
/Ua N(V14, s T ZF, N, R 12 E (or
7 S MAILING DREn LOT # BLOCK #
PROP
CI W. STATE ZIP CO E PHONE NUMBER SUBDIVISION NAME OR CS~/M NUMBER
let U~vG~jL- Z..Z Z 71) 5W-S O r- 9(L `F~5'
CITY NEAREST ROAD
L:I
11. TYPE OF BUILDINO: (Check one)
❑ State Owned O VILLAGE : ® ~al6E
❑ Public K1 or 2 Fam. Dwelling-# of bedrooms3- PAR E TAX NU M )
III. BUILDING USE: (If building type is public, check all 7;;9 d ~D Q
1 El Apt/Condo l 0
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. sruaw 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 ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) p 6 ELEVATION
7t
b'i s„ r^Feet 3r. Feet
45 L *f ~
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank -
Lift CN~t~FGt
Lift Pump Tank/Si hon Chamb El I El F-1 F1 =M] ~ =EEII
VIII. 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 ignature: (No ps) MP/MRRSW Nb.: Business Phone Number:
6 .(/C ZT
Plumber's Address (Street, City, State, Zip Code):
i5-wt w
IX. COUNTY/DEPARTMENT USE ONLY
L] Disapproved Sanitary ermit Fee (Includes Groundwater a Issuing Agent ignature (No Stamps)
Surcharge Fee)
41 Approved ❑ Owner Given Initial
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 r
1. A sanitary permit is valid for two (2) years.
2. Your sanitdry.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 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 fil:! 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, vocation 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; rew+acemert system
a( as; and the location of the building served; B) horizontal and vertices' elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufai.turer; D) crops section cf 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 rumba r of
regulated practices which can effect groundwater.
The monies collected through these surcharge,n are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (8.11/88)
STC-100
This application form is to be Com let .
the o1;'ner p ed in full and signed by
(1t) Oft the property being developed. I in
will on " ade
development be delays of the permit issuance should thi Y 9uathis
house) intended for resale b s
then a second form should be retainedrand -completed when
the property is sold and submitted to this appropriate deed this office with the
-----------------record-------------------
.
Owner of property
~cT
Location of property rU =
~=-1/4 1 Section ~ EL, T22S~N-R
.Township DW
Hailing address ~ /cf_~,-~
Address of site A- d
Subdivision name
[!0 ~C PZ~SLot no.
Other homes on property?
-yes__C=No
Previous owner of property (C
X
Total size of parcel
Date parcel was created 2
Are all corners and lot lines identifiable?
I s this '-"-------yes ~_No
property being developed for (spec house)? .yes
of Dee_~_J bnd Page 2tufiber No
of Deed as recorded. with the Reqis
ter
-
T14CLUDE WITH THIS APPLICATION THE FOLLOWI7
A Iallttttlttl•.Cy ULLU which includes a DOCU i G.
MENT 11UMBEIR & TIII• SEAL or THE 1LCGISTrR of DEEDS. In ad iAND PAGI;
certified survey
dela s , if available; ;would be helpful so asd to avoid
y s the reviewing process.
references to a Certified survey map If the deed description
shall also be required. , the certified Survey Hap
PROPERTY OWNER CERTIFICATION
I0,1e) certify that all statements
best of ray (our) knowledge that I (We this form are true to the
the property described in this informati n form the owner(s) of
warranty deed recorded , by virtue of a
Deeds as Document T1o, in Iye Office of the Countw
own tlle proposed site for the sews e' and that I eRe9ister of
obtained
own tied an easement 9 disposal system) orr Ie(we)
construction of ,said run the above described
the recorded in the office of Countm' and the same haeopbeen duly
No, y Register of deeds as Document
Signa ure of ~8
P~1 ant
Co-appl cant
a Z_
9
D
ate of S na
g ture
bate of s gnature
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
l 489865 vo 974PAGE 361 REGISTER'S OFFICE
ST. CROIX CO., WI
Rolling Hills Development, Inc., a Wisconsin Reed for Rewd
corporation OCT 13 1992
at s:3o A. M
conveys and warrants to Eugene 0. Larson, Don D. Kruger,
and Lawrence M. Johnson, Jr., d/b/a Quality
Built Homes C~
Register of Deeds
RETURN TO
the following described real estate in St. Croix County, I
State of Wisconsin:
Tax Parcel No:
Lots Sixty-Six (66) and Sixty-Seven (67),
Oak Ridge Acres to the Town of Troy.
~RR~;SFi~
This is not homestead property.
(is) (is not)
Exception to Warranties:
easements, restrictions, and rights-of-way of record.
Dated this 12th day of
C.
(SEAL) (SEAL)
• Richard N. Fox President
(SEAL) (SEAL)
Frances J. Fox, Secretary
1a
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Richard N. Fox and STATE OF WISCONSIN
ss.
Frances J. Fox County.
authenti ated is 12 f
day,o October , 19 92 Personally came before me this day of
19 the above named
C. L. Gay ord
TITLE: MEMBER ST TE BAR OF WISCONSIN
(If not, tome known to be the person who executed the
authorized by § 706.06, Wis. Slats.) foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
C. L. Gaylord, Attorney
River Falls, WI 54022 Notary Public county, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission Is permanent. (If not, state expiration
are not necessary.)
date: , 19
Names of persons signing in any capacity should be typed or printed below their signatures. SB2 • NTF 0021
WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208
Form No. 2 - 1982
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER~C (`C GI ~Ct~~ ~~~X
ADDRESS: ~f FIRE NO:
LOCATION:/ 1/4, AJ W 1/4, SEC. q+2-eN-R_~? W~
TOWN OF:-- (S
ST.•CROIX COUNTY
SUBDIVISION: 9 S LOT NO.--
n
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 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 form must be completed and returned to the St.
Croix County Zoning officer within 30 days of the three year
expiration date.
(910 4
SIGNED: l
i.
DATE :
St. Croix County Zoning Office
911 4th St. _
Hudson, WI 54016
Wiscarisin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ST. 'Z'V- A L-X
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 PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 00- 1 I $ -90 _60 6
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Qum l 0cm QV L 5 GOVT. LOT UI,,j 114 N W 1/4,S 36 T Za N,R 19 E (o~W
PROPERTY OWNER':S MAILING ADDRESS LOT # T BLOCK # SUBD. NAME OR CSM #
N2T3 30x 66 - o~1r~ CztDGE Rc2e`s
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE IRTOWN NEAREST ROAD
Z>u rteus SVoZZ. (ols) 4 zs-zlzZ Z-1~p wao~cz~osE U7~1ut=
j~ New Construction Use Residential I Number of bedrooms -3 [ j Addikn to ebsting building
j j Replacement [ j Public or commercial describe
Code derived daily flow Lk S O gpd Recommended design loading rate o...4 bed, gpc!0 0 - s trench, gpd/ t2
Absorption area required `ZS bed, ft2 00 trench, 11:2 Ma)amum design loading rate c -y bed, gpd$ 0. s trench, gpdAt2
Recommended infiltration surface elevation(s) S e13 P1'c6e 3 OF 3 ft (as referred W site plan benchmark)
Ack0mal design / site considerations -M ~ c-M eS I'2r R.e C-O M ki &JDtED
Parent material o u*T-w r %S t`t Flood plain elevation, if applicable fy A • It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U=Unsti le fors tern Ims ❑u L$S ❑u ®S ❑U ®S ❑U OS ❑U ❑S P U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mother Texture Structure Consiswnce Boundary Roots GPD/ft
in. Munsedl Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
E3 Z!z - Si \ z sbk `yn'F-V es o.S 76
Z \-Z6 1r3 t C_ 31q - S 11 2- 3 bk m~ C- S 0.5 0.6
Ground 3 z$-Sy \o `-I V_ 3/6 1 S C Sb\c vn v eS 0.4 0. S
elev.
q'i-la ft. lsv--)8 tZ''m V/ W\ o. s o. ~o
Depth to y eD+v ~v S Fek> > Z 1.-S Sri 02Ts
limiting
factor 8
Remarks:
Boring #
1 0-11 ZO`12 Z/z Stti Z`Fsb1~ `m`Fw cs o.S 0 6
2 2- t\-31 10'?R 3/yr - s\~ 2_~ Sbk y,~ ~h cS o.S o-JL
3 31-SB luL1R 3/(. - S C Sbk -M U F►- cS a•y o.S
Ground
elev. sg - 86 1 O `i R Y/V - s O S yv) ~ o . S o. 6
°13-aft 9 10
Depth to ~ s ` uo`~ ft 13 I W ~ .
limiting sA
factor
> 86 '=ss~
Remarks: 02
T Name:-Please Print p~ ke , Pho e:
Arthur L. We ever T 15-425-0165
gerer Soil Testing & Design Service- ..6 ox 74 Ri er Falls,WI 54022
Signature: +p r_~ 4 t0' CST Number:
d( s-P.30, 14°tz yet o 0 576
PROPERTY OWNER QQJKUI M -eSy0,--T SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # O 0 - 1 l$ $ - 0 - 00
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed reach
t 3 1 o-t8 v0-i 2 Z-1 -L Stil -'FSb1T yr\ GS o.S o.6
Z
►8-3S to `2(Z- 31y Si 3bk mcS o. S o-{,
Ground 3 3 S S0 to V 2 3J 6 - S C S bk vh vj c S O. y o.S
elev.
9Z.2. ft. So $Z )0`22 y/St `~S O S9 w1 1 O- S o•
Depth to L~ S P` rr N u TLs ft 1
limiting
factor
8Z
Remarks:
Boring #
o-1Z lo~t2zlZ - s11 Z,~k M~~ es o•S€o.b
y Z 1Z-Z~ 10`iQ 31y - Sly 2 f 3~lr W -A eS o.S n.~
3 2M-SL 10 Y 2. 3/6 - S 1 C- 3 ~ Yn U'F , S
Ground
elev. y Sb-8`o I0 14 2 V/y _ ~S-S\ `eS~~ o-y o.S
q~ ft.
Depth to
limiting
factor
Remarks:
Boring #
o.s 0 6
SON". ~-~3 l0`i2 z L Z s i Z`FS>,k v~`~1. c-S
Z \'S-30 to Lit 31y - S) Z `FS ~lT ~'"1 'F~^ C S o. S 0.6
3 30 39 1~`~1Q 3/6 s~ 10- Sbk Yn v o• y 6•S
Ground
elev. U 39-$0 1 u Y2 ~/y ~S D Sg o. S o. b
ft.
Depth ID
limiting
factor
> So"
Remarks:
Boring #
E3
Ground
elev.
ft.
Depth tD
limiting
facto
Remarks:
S8D-8M(R.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= 30 '
i
I
woc~pR~DGE• 1!s21uC West-
8!~ .a8.6` av 'fia/-gw► _ ~.~oo.o' o-.) Zap.
b~- G12~~J v►.~pl3l2GRUU►~,p of u'~0~2G2UUN0
~`h~1~ Qox v~-►~.rry tux ~ ~z~~
k
1
IL
t-4 ~~oust `CO O1 P}T L1vA3T Z$' PRAM
YmIJsie S`-~S~ A~Lt`q, WALL "tai t?, RT
SST Sp' r=-lzo M Ste! Shs1~1 .
0
fy yT~' l-0 11~SlYt ~\.~c _ s 1
b ~ ~'RRT W~"lT~-1N
~L Sv~T~cAI~ R'R~A f
S~tvv.►'N. L►'~-F ~c~s I
~13LAAQgLope
~ C~,} L3LLSl1 P'C'T'1 l1 N S+_T.L 9 3 ?
~v~~ w G dD~► 5 r-t ~ N
srQ,uc'nufJ , I .
V' lF~j l_oT Ll.u S s'M1,,
e ~FoCc~ C.o>v 51'Q_u cTiurr ,
r3.3
E 93 3
G Z- Z Ito,
SepVZ-9, "Y Z (-Ils)y2,5-Ol6S V~tuos~6
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ST• C.QsJ Gx
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 PARCEL I.D. #
ro
dimensioned, north arrow, and location and distance to nearest road. 00- 1 M-q O _06
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
QUVN k_L'rq L3UL L_Y EkUt'1 ~ S GOVT. LOT NL-,3 1/4 Nw 1/4,S3L6 T 2r8 N,R I q E (o l
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
'S a% Y, -7 66 - o1a,%yr- CzLDGE Rc2es
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ]MOWN NEAREST ROAD
pwj etc S k3 SVOZ2. (-)IS) 4.ZS-7_lz2 '~gp 1LA-*'oo'bV_Lbr.E -Decue
j New Construction Use Residential / Number of bedrooms 3 [ ] Adddiqu to existing building
j j Replacement [ ] Public or commercial describe
Code derived daffy flow q S o gpd Recommended design loading rate __o.,_4 bed, glxW 0 . S trench, gpdtfi2
Absorplon area required ~ VLS bed, ft2 OO trench, ft2 Mandmum design loading rate o • 4 bed, gpd/rt2 0 • S trench, gpdtft2
Reoanrttended infiltration surface elevation(s) S EIS- P1'rsi-~, 3 of _:aft (as referred to site plan benchmark)
Addltionail design ! site corusiderations TQ-e,1J c-M E S PCQC RIE~. c.0" n 0-J .DtD
Parent material o UyAAj R S N Rood plain elevation, if applicable -1a • It
S = S"e for Sy8tEKtt CONVENTIONAL MOUND KGROUND PRESSURE AT-GRADE SYSTEM IN RILL HOLDING TANK
U=Unsww*for tern ®S ❑U [as ❑U ®S ❑U 0S ❑U ®S ❑U ❑S MU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consist) Bound3y Roots GPD/ft,
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rent
1 Z/z - S),\ z~Sbk e- S o.S o:b
z to~tLz 31Y - si I Z~3"ok wcf - cS o.s o.f.
Ground 3 Zg-sy \o `1 Z 3A S \ C A c yr~ v `S o• a 0-C'
elev.
q51-$ ft L,F SX7$ to`12 V/ - ~S v S~ , o. s o. b
Depth to
y trvu tv S Felv \ ZL I S sn T s
limiting
factor 8
Remarks:
Boring # 10 ~1 zlz S t ti Z sbk `n-L c S G. S o. b
1 0-11
2 Z 1\-31 10`12 31Y Ak CS o.S o.b
3 31-SB 1u~2 3/ie - s1 lcsbk rnu~►- cs 6.V a•S
Ground
elev. Lj s$ - 8b l O `1 R YA/ - S S S Yn~ C). S o. 6
013.3It
Do b S L t~o`TE ~ D I t~ ~ .
limiting
facf3or
y 86
Remarks:
TName:-Please Print Pie
Arthur L. We erer 715-425-0165
eg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Z_ z i 6 Date.' 3 0' 1 °l z CST p 5 7 6
PROPERTY OWNER wvt~~l b`1~LT SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # O 1{ 0 ' 1
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Try
7- rn'~ ~s o, S o, 6
Z 18-3S 10 `ZQ 3JV - S1 Z J~k YYL'~1~ CS 6-S 0,6
Ground 3 3S SD IQ 'ttz 316 - s 1 cSbk v, \j eS o.V 0"S
elev. n9Z.7- It. &D-$Z ►0`22 Yl%l - `I-S s~ yn °•S ;o.~
Depth to L~ S h r u uT`?- Pl R
limiting _
factor
> sz
Remarks:
Boring
o.S 0.1.
y Z 1Z-Z) IZ'1Q. 31y - sly 2'F3~k vr•'F1. eS 0•S =n•L
3 Zn-SL IOY2 V4 - S~ 1C.Sbk YnU~~,
Ground
y Sb-$D 10LfIZ V/y _ ~S- S~ `O-S OZ Yn ~J O•y 0.5
Depth to
limiting
factor
Remarks:
Boring # 1 v-~3 l0-te Z L - S L Z`~S~k wti`FI. GS o• S D. 6
. 6
Z ~3-30 10 4t 31y - S t Z `FS~lq Yvl c S o. S' 013S
3 30-39 101-1t- 3/6 s CS~k w► v~~, aS o y 6•s
Ground
elev. U 39-$0 1 p Y2 L//y `FS a Sg f^~ o• S €o• G
q3•Z ft.
Depth to
limiting
factor
> SO '
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-MO(R.05/92)
PLOT PLAN Page of 3
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CST Sianature _ Date Sione Teleohone No. CST #
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REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1
12/02/92 17:36 REQUESTS FOR INSPECTION WORK SHEETS FOR: 12/ 4/92 AREA: JT
Activity: A9200383 12/ 4/92 Type: CONVSEPT Status: PENDING Constr:
Address: TROY 36.28.19.819,NW,NW, LOT 66, WOODRIDGE DR.
Parcel: 040-1188-90-006 Occ: Use:
Description: 180302
Applicant: QUALITY BUILT HOMES Phone:
Owner: QUALITY BUILT HOMES Phone:
Contractor: NELSON, ROGER Phone: 273-4444
Inspection Request Information.....
Requestor: NELSON, ROGER Phone:
Req Time: 14:12 Comments: c~66
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I