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HomeMy WebLinkAbout040-1188-90-007 CD O O v rj C c ' tr o e~ (D o o ih ry x I O Bo v co 'A o I E I o U r ~ I T U C n CO O Cl. m w N 0 Z E Li c ° a o 6 a Co s c Q U l0 I Z N z w O v p Z - s m a M F z a m i I o z °c r CD Z 2 C !n F- r Y) a -O N N ~ O O C 'n (D c C~o ~~14 N • ~ p a m N C~ O o Q) Z co z p N N Z O N ~M U Q _ N m O > d O > Q m w co'coa` o LL E N o (o X000 •rv m w a a a CL ► ° 1 C\j N to U a w rn } v O N O O 00 cu "i C ~ o E w c o ° ° c E ~n 0 c y c N CL p Q yr N O o m = c E v l i t N c0 [ H Y - O W ,try), O' N ` N L Z` ~ r • ~V y'in' O co I- O NI 7 Cn r p ~ w _ E I w Xk a a a • CL C U d d ~v £ U C w C i w C 0 as 0 U) U rte,. r, sx AS BUILT SANITARY SYSTEM REPORT OWNER L..M- (T11 J3 4(l(-_F 'TOWNSHIP SECTION '36 T Zy N-R__aW ADDRESS_ 8 C)k ST. CROIX COUNTY, WISCONSIN zw&t ~5 ICJ 1 S0 SUBDIVISION-Q_/±f SLOT 6 LOT SIZE-/ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~dT- 67 COF 6 6 e Q~LV ~a r- uOT #ausC- 6&A6& c-j d L ~ 5~7TC Tq^K t~ 6 Ict-g (ANSrC(T BL C` INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark ]~2yf A'&se- g,¢fe-kz z!:n-AJ 7 SEPTIC TANK:Manufacturer: W ~/r2s Liquid Cap. Rings used:&Manhole cover elev: 5--`'Final grade elev: Tank inlet elev.: Uri Tank outlet elev.: No. of feet from nearest road : Front ~`SSide , Rear Ft . From nearest prop. line:Front?' Side , Rear Ft. No. of feet from: Well Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE R Jf J PUMP ER i' Manufact er Liquid Capacity: Pump Mode Pump/Siphon Manufact.: Pump Size Elevatio of 'nlet: 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 ABS RPTION SYSTEM Bed: Trench: Seepage Pit: Width: 1.-Length___Number of Lines:_'~_5Area BuiltL2~~ Exist. Grade Elev. Proposed Fina~ Grade Elev.. Fill depth to top of pipe: No. feet from nearest prop. line:Front-6-, Side , Rear Ft. No. feet from well: V14- No. feet from building HOLDING TANK Manufa tur Capacity: No. of i gs used: Elevation of bottom tank: Elevati of inlet: No. fe om nearest prop. line:Front , Side Rear Ft. No. fe t from: Well , building nearest road Alarm Manufacturer: INSPECTOR: A DATE: -7 ? PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj PUMP ER Manufact er Liquid Capacity: Pump Mode Pump/Siphon Manufact.: Pump Size Elevatio of `nlet: 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 ABS RPTION SYSTEM Bed: Trench: Seepage Pit: Width: 16-Length Number of Lines:?~Area BuiltL-?,:K Exist. Grade Elev.-2q, 5G Proposed Fina Grade Elev. Fill depth to top of pipe: 46 / c2 /9 No. feet from nearest prop. line:Front_, Side , Rear Ft. No. feet from well: ..N om buildi s KILty r HOLDING TANK Manufa tur apacity: No. of i gs used: Elevation of bottom tank: Elevati of inlet: No. fe om nearest prop. line:Front , Side , Rear Ft. No. fe from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: 06~~G s v DATE : f=_ PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj W&W-~,{~ NattmTAQfYt n j,28.19.820,~j~7,~1,5,,~QG7CQJRIDGED D { r ~ ds~ R' V ' C CYV CM y: Safety anHuman Relations Count Safety and Buildings Division INSPECTION REPORT ST. CROIX GENE RAC INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 01 180303 Permit Holder's Name: ❑ City ❑ Village ❑XTown of: State Plan ID No.: TROY TIALITV BM Elev.: Insp. BM Elev.: BM escription: / n Parcel Tax No.: lS d's 040-1188-90-007 TANK INFORMATION ELEVATION DATA A9200384 Q TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic GJ~ Benchmark - 3/ QLj,kj Dosing o 13,E O " 2,(0., Aeration Bldg. Sewer Holding St/ Inlet G p3~ 93 TANK SETBACK INFORMATION St/t Outlet a ° Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Wet~ Septic 3 NA Dt got m Dosing NA Headert-NI 7. , Aeration NA Dist. Pipe D Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 5, 33 t~ 3~v Man urer Demand S 0 Model Number GPM TDH Lift Friction S tern TDH Ft Forcemain Length Dia. Dis . SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /If ~3 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/ STREAM EACHING Manufacturer: SETBACK CK~MBER INFORMATION Type O Crt , / Model Num 0 tGJ OR 0WJjT System: ir-Y DISTRIBUTION SYSTEM Header 4h&mm4oH-" Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length I XI Dia- Length ~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over „ I xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edqes Z7 ` Topsoil E] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 36.28.19.820,NW NW, LOT 67, WOODRIDGED DR. WEST c/O fj Lq) 7 Plan revision required? E] Yes o Use other side for additional information. fZ d SBD-6710 (R 05/91) Date Inspector's Signature Cert. No f ADDITIONAL COMMENTS AND SKETCH - SANITARY PERMIT NUMBER: 17 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY tom 5-&- CA? 0 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ifalato7n 8% X 11 inches in size. ®r. us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY OWNER PROPERTY LOCATION AL t u1LT In erS Nos Al Vl,a, S j T Z~IV, R E (orklg) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # O Y, 67 1 CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER lUC-2 FkLS w( o z.z ~(ZS 53,g f 10 A-Cffc- 0 S II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) 11 State Owned ~j VILLAGE : wo-al 2t' Q~ ❑ Public ~ or 2 Fam. Dwelling- # of bedroomsL R EL TAXNUM`B'ER_( 111. BUILDING USE: (If building type is public, check all that apply) i9 0 Q Q 7 1 ❑ Apt/Condo C/ v l l 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 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. RNew 2. El Replacement 3.E] Replacement of 4.0 Reconnection of 5.0 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 12eepage 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) BE ELEVATION f 5-0 Q FT6e1A+et t° - 7NFeet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION Tanks Tanks strutted Septic Tank or Holdin Tank? W Lr-L I ~A_ 77_1 F1 L Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu is Name (Print): Plumber's Signature: (No ) r6? P/ No.: Business Phone Number: Cs 9 L6 Plumber's Address (Street, City, State, Zip Code): L C-- -L-k cx ^ LA t~ S o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanita~ermit Fee (includes Groundwater ate Issued Issuing Agent Sign re (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial / Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: v 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 amp 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. Vill. 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; scil 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. GROUNDWATEiR SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fo a nun,.,': of regulated practices which can effect groundwater. The ri,onies collected through these surcharges are used for r>icnitorin( cror, _d~rtir<ater, cg,ouncl water contamination investigations and establishment of standards. SBD-6398 (8.11/88) C off" P 301 n c g 5 csT 1 Go 6 7 P~Vgf ` o'er bR~ 4~~~ 6 4 vg`T sx 6o i D I 776 Leo 6y 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 • _S T..c.1z01 ~ 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. O k40 - 1 I $ $ 9 0 - 0 0~] APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Q U NN L Vt4 13 V t L-T lyvr-1 S GOVT. LOT N W 1/4 N lV 1/4,S 36 T 7-8 N,R ICY E(060- PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # \T 3 t30X 7 67 - oN\-C-P-t DGE ft clZe-s CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EFOWN NEAREST ROAD \.wev- e~ML_S, k)l S Vo zz hls) L4zS .2 tzZ ~-~oY woooRL~Ge _t)tiue ( New Construction Use Residential / Number of bedrooms 3 (j Addi4Q9 to ebsbng building j ] Replacement Public or commercial describe Code derived daily flow LAS O gpd Recommended design loading rate o • y bed, gpd/ft2 0 • S trench, gpolft2 Absorption area required \ Z S bed, ft2 0100 trench, ft2 Maximum design loading rate o , y bed, gpdfit 0, S trench, gpd1ft2 Recommended infiltration surface elevation(s) S c~C 3 fit= 3 ft (as referred to site plan benchmark) Additional design / site considerations ` Ctt s - Wit- cg' ~ . Parent material O uT>ti S N Rood plain elevation, if applicable t~1 A - ft [UTUnSMW r system CONVENTIONAL MOUND IN-GROUND PRESSURE GRADE SYSTEM IN FILL HOLDWG T for System IBS ❑U ®S ❑U LAS ❑U ®S ❑U I?S ❑U ❑S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft, in. Munsell Qu. Sz. Cont Cola' Gr. Sz. Sh. Bed reach 1 0-0 do Lt Q zlz - s i Z stile m eS 0.S o.6 It Z 11-3 10 ~Q 3/y i sl l Z~ g~12 w~`Fh c s o-S 13.6 Ground 3 2-Sy Irs K7__ 316 S~ C Sbbc `m\J k 0-S o •q o.s 0144 y sq--1$ \ o-I V_- L/ q - T v gg vy~ I s o b Depth to coN AJS F lnr-Z" L S l c~-i S limiting a„ factor Remarks: Boring # ' 1 0-11 WoKle. alz - s Z~~1~k mph cS 0.s o,6 Z Z 11-~1 )o`t2 3!y - s I Z~abk cS o. s v.6 S 1cs cS a~1o S 3 3)-s$ 10LfQ 3/6 Ground elev. y S$ _ g6 10`7- V/y - ~s 0. S a3.3 ft. CF ~ W~-t0 ~ Sit ~ 1v old RS Q ~ Prt3ov L (b limiting factor Remarks: `9 T Name:-Please Print fqe " Arthur L. We erer~ 5-0165 gerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: > Date: CST Nwnber: ,Z, 9 z- 2-~7 S~.30, lq`tZ V~1 Uo 576 PROPERTYOWNER QUN,Vv~ $Ut~~ SOIL DESCRIPTION REPORT Page '6f PARCELI.D.# O~ - 11$g.-40- 00'7 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary RootsGPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre& o -1 2. Z. 1 IoHQ ! - s i 1 Z s~k `rn cS o.5 o.b v>> Z 11-3. Z- 10`IZ 31~ - S)) s'bk Yn o-S n,(o Ground 3 3Z_y7 lp Ytz 3l ` _ S C s~k M u o-y O. S elev. C~Z. I ft. L4 477-7)8 loKQ Y!y - FS-S I cS~k M U'ft- o•y o•S Depth to findting facts $ti Remarks: Boring # - 1 0 11 10 2 z.l Z S, , -2,+S c S o• S o.b Z 11-3L 10`1l~ 3/ _ S Z'~ S ~k n1 `F►- c S o-S ` o. 3 31,-Sy loY2 3A - s 1 csbk h1 U1. o- ~'o-S Ground elev. y s~-~o t~~rZ y/y - ~s-s~ 1 cs~k v~f►- o ~o s qZ. G ft Depth to limiting factor 86" Remarks: Boring # , t:3I 1 D-lD ~17~2 Z12. - S 1 1 2'FS ~k w~`f c S ~•S o 6 S Z 10-yf IL)4[z 31y s1 Z~S~1R m e g o,S o.6 Ground 3 yl_53 ~o`i2 3/6 - S Cs~lz YnUi- C S elev. , y S3 -7)„ l b `1 R 4/ / - Fs - s ~ 1 c S DtiC V►7 u'F 1- o • ~ o S Depth to oav A, S~ i z `L S r=~LR C+~t/1' ' t o Ktz 313 limiting fact y Remarks: Boring # l p ,.11 10'12 i C 2 s 1 'Z.' S bk'Fti- c S o. S 's o, b 6 z )I-33 10~R 3/y s1) ~9bk m~~- ~s o,S 0.6 3 -s b 8 ~Lsk>- :!A g l 1 e S>ak kn U-f+-• e S o•y o. S Ground elev. y SB-7) S 16V 2 Y/Y ci~•Zft. Depth to S E ivn7t R BS ~s3u~~ limiting Remarks: SBD-8330(R.05/92) PROPERTYOWNER Qv'e~c,\,VT" ~3y1~T SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# D~Q - Bg-~?0- DWI , Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 o-1I 1o`-JQ Z /z - sit Z sbk `n c.-S o.s o.b t1- Z 3Z lO4 tZ 3 m fit- es (S.S o-(, Ground 3 3Z_ 10 Ytz. 3 _ C S~ U` o-Y 0-S ~ l` S ~ ~ tic n1 ~1- elev. aZ. i ( J - c vn f o• o. t. L/ 4~--,g o ~ ~ V1 o s- I 1 sbk ~ y . s ~ s Depth to tlnatlng factor , Remarks: Baring # 0-)1 1oy2z.1Z Z s1 +s~k m`FH c5~ o-So.b Z 11-3L 10`1 31 _ S)) Z'{'s ~k ri1 `Fly c S o,S o 3 U-sy )0~2 3)b - S) cs~k m l>`f I. ~w o- y o- s Ground elev. y su-&o ~ oYtZ V/y _ ~s sl 1 cs bk m v o ~ s qz. ft. Depth to limiting factor '7 8611 Remarks: Boring # 1 D-lD \rj4v- -Lit s Z to-yl 104rt 31y s~ Z~sbk m 1- eS o.S'o•~ Ground 3 y l_ 5 3 0 `1 lz 9/ 6 - s c s ~lz Yn U `F - C- s o y o• S elev. S3--)J, )L)LI2y/ - Fs-sl ~esbk YnU-~1- fL o.t4 os ~ S LS ~z-n cr►vt- - CIO LIP- 313 Depth to limiting factor y Remarks: Boring # 1 o-1) \o - z[ Z - s i t Z s ~k w~'F~ 5 0. s': o, b o z )I-33 10~~3/y si) Z`~sbh v~~t- ~S ~ o•S 0.6 'Z -J3-ER \OLitz3/b _ S I l c S~k vn V`F~ e S o.y a. s Ground elev. y S$:-) S W-fk v/y kv,vf\~ o.y `o.s a11•Zft. Depth to CLD kw e- fu aTL- R 8S limiting factor > "IS . I Ll Remarks: SBD-8330(R.05/92) W.Uonsin Npartment of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Bui Icings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site pi an 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. W40 - I.1$ $ - 90 - 001 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Q U ` N I-1. ni 13 U l l-T 1-tv.)n Z-s GOVT. LOT N V1 1/4 N LO 1/4,S 3ti T ZS N,R I C/ E (o® PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # ~ZT 3 t~(.NX 7 6-) - 0Mt- W o 6E ftc-zc S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE EFOWN NEAREST ROAD Zw e- -L,L_S, )I S ~!o z z (Its) ~zs ztZZ wa~D12LD6e vw~e New Conshdon Use (Xj Residential / Number of bedrooms 3 [ ] AdditiRrs to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 4S O gpd Recommended design loading rate o bed, glxW 0 -s trench, gpol(t2 Absorption area required \ L S bed, ft2 °I00 trends, ft2 Maximum design loading rate o , y bed, gp(/ft2 O, S trench, Recommended infiltration surface elevation(s) sit k7-)AG,(3 It (as referred to site plan benchmark) Additional design / site considerations `1"l~~yCkFL-TS rl-V-N TzEECA ki g?UDeIA . Parent material D y`M.x N %N Flood plain elevation, if applicable tit • R , It S = Suitable for SyStenl CONVENTIONAL MOUND F W-GROUND PRESSURE 7Tffis A DE SYSTEM IN F LL HOLDING.TANK U=-Unsubble for ®S ❑ U RIS ❑ U S❑ U ❑ U [us ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft, in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed sends E3 1 0-l~ ~oHQ z(Z - Sj -2`e sbk M C-S 0•s o.6 2- II-2-8 LO -17- 3/y - S1 ~ Z~' 512 ►,~`Fh c 4 o-S o.6 Ground 3 ?$-S4 lr'~ kR- 3% Sbk `f\\J k C -S o.S elev. q ft. S4 -n$ 0,j 2 vlq ~s 0 Sg rn o S o,b Depth to coN NS Pty )11--e L S FV_j 6i-1 S limiting bCtOr$„ Remarks: Boring # 1 0-11 ~oK~ alZ - s ~1 Z~~l~k mph cS o.so,6 Z Z 11-31 )oYl~ 3/y - s t 1 Z~sbk r~~y. cS o.s' v.6 3 11-S8 10 BIZ '3/6 - S I C s'b k Y) U - c S a tq S Ground elev. L4 S%- K 1,011t V!y ~s p S9 I 0- S ` n, 6 g3.3ft. Depth to S h L w o RS Q Prt3ou N limiting .-flip Remarks: TName:-Please Print R'o1e' Arthur L. We erer 715-425-0165 g rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: 9 i- Z.k7 st~.3o, 1992 . Y`-t c)d 576 PROPERTYOWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D.# 040 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxktiy Roots GP.D./ft in. Munsell Qu. Sz. Cont. Color Gr, Sz: Sh. Bed ranch 1:3:n cS 0.5 Z t.1-3Z %-Jt L31y - s1 J sbk >n'FI- eS o,S o•6 Ground 3 ~Z_y7 lOYR 3~6 SI CS~1T h'1U`Fy O•Y O•S elev. WL.I ft. Lf ~8 10'-12 vl - S-S cSbk ►n U'Fi- o•y o•S Depth to limiting factor Remarks: Boring # , 1 0-11 1o~2zlz - s1 ~ Z-F-s~k m~~. c S o-S o.b Z 1I-31 1O`1Q 3/ El- S) I Z`F S ~k ri1 `~l^ c S o~5 ; v b 3 3b-Sy )072 3J(, - s ~ 1 CS~k val. oQ.w • o. =o- S Ground elev. y Sll-8o 10Y2 VII - ~s S] 1 c5 btic Yn L) o • v o •s CNZ. G ft. Depth to limiting ' factor 86" Remarks: Boring # 1 D-~D t0~-!R ZI2. - Sl~ Z~S~k rn`~►•. cS ~•S 0•6 h S Z 10-y) log- m 3Jy sl Z~Sb~ m e S o,3o,6 3 yl_53 10`ttz - S 1 \ as~lc vnUi- C- S o•~! :o,S Ground elev. S 3 _7 1 u `t 2 y / _ 'Fs - s ` C S ~1rC Y►t U 1- o • 0 • S q 3, 1 ft. co\i w SQ l ZLS F ~v1- - { u ~t2 31 Depth to 3 ) limiting factor i Remarks: Boring # ~ 2 )I-33 1o'41L3lY ~ gl~ Z`~9b>z mil- ~S o.S = 0.6 I'3 ~3_S8 ~0`~~ 3~b _ SI 1 a3~k ynU~f+~ ca s ©•y o. S Ground ' elev. y S8-~S L6`f1 y- ~s-s~ \c31~k. ihv'Ftr o•~!'v.s 01,4 -,Z ft. Depth to C LID fu nTL' 8 S rmove- limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' wo~~ 2.~D G E 4R.1 UE wes T 98.9 oN 'mP of `~31~1 -8.100.0 0~ luP OF vti~1. ~t6itUVN s~ yr ~.lyy ~D~R62ot>rvO ~Y'i~tYy $ox 8o x c 44 2n, 1~tivsF'1o Bz- Kf Le *T ZS,FRN1 S,tSr&l _ 10 0 O ^j O nl Sv ~`tvh3`L PAZ-~P1 C~-01Z 8 ~(o" Rytccr sYsTis Nll`C~ yip Uu STPMU,, ' I d S ~M t N . 1l~sZ1P~t~ l90 LINL°'PrL ~ o s Or- S ~w~p~ 1RE7UCk~~ S Rr U-vftsr 6' q p .i. B s E- Ct 3 w1~,1J 'T}lE Sv~~~ ~ I ~ . St~vw 1J. t~~-pcC~ `CRk~Ck~ / 36`` tom' `Ttr1~ I / DOwN SL.ppr~ '~6e _ ~ tit. az I B4 ~i~ck{ e-JEFU/'MO".s To tit, QZ L3~ ~~y''! fN~ D~AlwG 'T-*t=_s z 2 PITS ep~,'`C1?,v c~0►v , I / «tiR-M S6~t~ UCH1 l~Y C.I~uN S ouNM %l w~~y c z~1 / w~oTTt:troG WT 32° B.3 I _ ~tTl- a12 ~ 8 2 B LsL gtZ 3 3 o _ L 9 t Sir Z4, t99 Z (~ls) 4ZS-0165 HOQS-)b CST Sinnature Date Sian "Telephone No. CST # PLOT PLAN Page s of 3 SCALE 1"= 30 woc~~2.\bGE "~JR.1~ >~~~T gq-8.. g8.q'o~ `roQ of 'SVI tuo.o~ oti1 WP oP v~.,~l~2Gituwv p yr wYy va~p Gtz>JUrvO ~1~~1`ry %ox ~Ox C vsf 'fib Bw hT LeroT Z s ~Fv&I s tsr I w~tL ~ _ 5 0 , 0 Ij o° N s~ t~ ~L LEA C--oCz s ~,.aya tyu`TEl- 'lb IN Sjl`1-t.ltT'Q f t>Js-vf-rLL teo Limit FeeT I i oi= S'Mai Ct{~S i Rr L~RST b' ~,p~T I ~ B s ~-q3 - Stbw ~ e P~~c E `11~G~g / ~O►vN SLOP L; G e _ [3 k'~ a Z ~ Cam) ~l .Ell l~7 O N S Tp I R z 13 ~ O ~"T~.►'~ 3~ tab DUt2.! AJG ~ ~ ~ _ t elln~ ~ I `fit ti Z P 't- s S6OF=S UC~-1 f~1 l~Y Ltn~~S / ou~~~ s\ wLN (Zj_a QL~OS M1N Y+1oTTti1n~G RT 32" ~b►v S`rR.u erp tv , B.3 I3 -L 017- B r lsL I 3 ~ c+ S )'111J , / ' -`Z- Z1-7. J S~Z9, 144 Z (~t-s 4Z-S-o/65 "00S-)b CST Signature Date Signed Telephone No. CST # STC-loo 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 V~A~ l Tom/ BC' T'. ~ S Location of property /4 ~W7/4, Section ''3 W .Township Q Hailing address Address of site C-j £ f-Z- subdivision name_ ~t9-K (D ~c2 d' 6-,5 Lot no. Other homes on property? es No Previous owner of property _ I C-2O Total size of parcel C/> Z Date parcel was created Are all corners and lot lines identifiable? Yes _ Y", No Is this ,p-r7~/yo/party being developed for (spec house)74Yes No volume 'and Page Number 31 /as recorded. with the Register of Deeds. 114CLUDE WITH THIS APPLICATION THE FOLLOWING: A WARIUUITY DLLD which includes a DOCUMENT NUIWER, VOLUME AND PAGE. NURB R & THE SEAL OF THE 11EGISTLR OF DEED5. 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 ny (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 ~*n~tteeoffice 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 at, 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. Signature of'apV cant Co-appl cant 1 D _)4 Date of signature Date of Signature SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BU40R.~~ I r~ f (_I -/Os S ADDRESS: 3 R Hsu ? FIRE NO: LOCATION: 4) 1/4, Nw1/4, SEC.- N-R4~9' TOWN OF: T&O ST.•CROIX COUNTY__,L_ SUBDIVISION:_6 (1Z (06 ~T ~ C 9- LOT NO. T 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 ro ram in August P 9 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 o 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. icf l~a VZO SIGNED:- i. i DATE: St. Croix County Zoning office 911 - 4th St. Hudson, WI 54016 0 DOCUMENT N0. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 48986Jr VOL 974PAIE 361 REGISTERS OFFICE T. CROIX CO., WI Rolling Hills Development, I1!t~ a Wisconsin S corporation ROC'dfor ROCOfd OCT 131992 conveys and warrants to Eugene 0. Larson, Don D. Kruger, of 8:30 A. M and Lawrence M. Johnson, Jr., d/b/a Quality Built Homes Register of Deeds RETURN TO the following described real estate In St . Croix County, State of Wisconsin: Tax Parcel No: Lots Sixty-Six (66) and Sixty-Seven (67), Oak Ridge Acres to the Town of Troy. This is not homestead property. (is) (is not) Exception to Warranties: easemelts, restrictions, and rights-of-way of record. Dated this 12th day of- Or- Qbp..r C. (SEAL) (SEAL) • Richard N. Fox President (SEAL) / (SEAL) • Frances J. Fox, Secretary t, AUTHENTICATION ACKNOWLEDGMENT Signature(s) Richard N. Fox and STATE OF WISCONSIN ss. Frances J. Fox county. authen,,4ated s 1 2 day.of October tg 92 Personalty came before me this day of 19 the above named C. L. Gay ord TITLE: MEMBER ST TE BAR OF WISCONSIN (If not, to me 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 count Wis. (Signatures may be authenticated or acknowledged. Both My Commission is y are not necessary.) permanent, (If not, state expiration date: , 19 Names of persons signing in any capacity shoulA be typed or printed below their signatures. SB2 • NTF 0021 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Fors, P.O. Box 10208, Green Bay, WI 54307-0208 Form No. 2 - 1982 S c p . p Q REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 12/02`/92 17:37 REQUESTS FOR INSPECTION WORK SHEETS FOR: 12/ 4/92 AREA: JT .Activity: A9200384 12/ 4/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 36.28.19.820,NW,NW, LOT 67, WOODRIDGED DR. WEST Parcel: 040-1188-90-007 Occ: Use: Description: 180303 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 : a;0b Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: ,00012 FINAL INSPECTION