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HomeMy WebLinkAbout042-1086-60-000 Q) o O c yo v h 0.. o o s ' ~ I o ' m I co q x N L O ~ ~ I Z ~ Y C ~I U o~ a c z N L m - LL co ' O m C)0 Q O: M d' N Z m U) - o L Z m a~i N w a co m - Z O 2 !!t o c aUi Z d ° c co E- C:' m m E a m a N 0 o 0 v m - o a CS' U N U c O w oN Z F- Z Z O O CY) w co N M E - Q1 N ~ > O) M y N N CL NG O w w Y _N d co O (ten G O It z II 3 3 3 ° `4 *i o O O r • rv m a~ a a a a a_ I p N N O N N fn r u ~ _rn _rn } I rn O N I O O N N ~J m O O t N M LO LO »i N O dl m d - O Co W _ - N N O p a2. O C O O 7 Q C J © ~ 3 U O w 0 0 co 00 p! a a c 0) o t N V O (p H In E C _N N N 4r O C~ (P N t O D O In L" of 2 M y F- N N N m o E u m O M > 2 O ~ ~ ~ to O r.. - L L - .C d I V m G~ a E3 T CL • Q. y d L n A v m 2 0 y c Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER rc~ h/al, ~k,-L TOWNSHIP G✓d ~a+ Q..~ SEC. -3 l T a( N-R W ADDRESS 155 ei' ,-Ptl 14~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ,/G LOT,,/L4X- LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a , } L INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used -54- x GL,y Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ll?d~~~~'p~,rJ Liquid Capacity: ,Aoyl Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,O Sideo Rear, %34 r feet • From nearest-property line ' Front,OSide,QRear,O i1 r feet Number of feet from: well lding: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) L As~!r_~sraL]}~f AS! /Tit1. - PUMP CHAMBER Manufacturer: Liquid Capacity: + Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: LengY h: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear, 0 Pt. Number of feet from well: kn G Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 2 Plumber on job: . License Number: 3/84:mj LOCA,TION:,WARREN 31.29.18.484A,NE,SW,31,65TH AVE. Wisconsin,Departmentofindustry, PRIVATE SEWAGE SYSTEM County: isa Human Relations INSPECTION REPORT ST. CROIX safety ety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149315 Permit Holder's Name: [I City ❑ Village)C] Town o : State Plan ID No.: HOLM TROY WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 042108660000 TANK INFORMATION ELEVATION DATA A920016 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 'c. - Benchmark / SdS~ /p0. Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 5,65 qk y_3 verit irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Septic -10, ),d I ` NA Dt Bottom q. 3 Dosing NA Header / Man. -?~S v, `73 Aeration NA Dist. Pipe 0/,yZ qCie` 6 cr! .s~: 9u.5 Holding Bot. System //L5qg 93.. PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well Fi SOIL ABSORPTION SYSTEM BED/TRENCH Widt Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 y DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O I / Model Number: System: Sd 1A OR UNIT CHAMBER DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) . Plan revision required? ❑ Yes ❑ No Use other side for additional information. t' y / ir~Lt d SBD-6710 (R 05/91) Date Inspe&o s Signature Cert. No. I ' ADDITIONAL COMMENTS AND SKETCH T - , SANITARY PERMIT NUMBER: ' i M =q!LnF4 SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CO TIIY ` r STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / LIt'I 3 IS 8% X 11 inches in size. ❑ Check if revision to previous 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 '/4 S T.2 I, N, R /g' E (or) PROPERTY 46WNER'S~MAILING ADDRESS LOT # BLOCK # 1 S- ~2/ 'ele- .r/ 6•J it/cc- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ED 11. TYPE OF BUILDING: (Check one) El State Owned ❑ VILLLLAGE r...r/ NEl, 6- R 7/t ❑ Public [91 or 2 Fam. Dwelling- # of bedrooms 2- PA EL x NU BE ) 111. BUILDING USE: (If building type is public, check all that apply) a Y? _ l4 yi O 1 ❑ Apt/Condo ~b 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. N New 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 N 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 LEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVVATION YS'o e02 S 3 U • S l 3 Q G Feet IVY Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank !~d [71 M F-1 _X-f El I F1 [I I F1 n - El Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: G t✓ r 11: a Apt h Lc $V# !(s Y 2 Plumber's Address (Street, City, State, Zip Code): AQ -TIC eV /7"' Rgel Al IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sar)ary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No m ) Surcharge Fee) Approved ❑ Owner Given Initial A v se 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 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. I1. Type of building being served. Check onfy-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 ex;1perimental 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 (8.11/88) 4 S' 4 ~l o 77~, /7, L/ 62 Itl V l 4 4 AOL, nAl j ~ ,g 3 n ~gGI~ I ? loo' sl~U e rJ Ate'" p~~'6T~r~ss mi,,s~' rrra.,c 2 r o 6 ` ~ ter log ~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION 'LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 53707 (1-163.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPM&XH MALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NE 1 ~SW 1/ 31 /T29 N/R 18kr) W Warren n/a n/a n/a COUNTY: S BU ER'S NAME: MAILING A DR S: St. Croix Troy Holm 1521 Ward AVe., Hudosn, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: IgAesidence 3 na/ IBNew ❑Replace 1-16-92 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUNDPRESSU : S ST -IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) E4 S DU CAS DU] S ❑U ❑ S ®U ❑ S JTU trench -1 If Percolation Tests are NOT required DESIGN RATE: [7FIloociplain, ny portion of the tested area is in the under s.H63.09(5)(b), indicate: Class 2 indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 67 BxD2 BORING TOTqq~~,~ DEPTH TO GROUNDWATER-INCHES CHARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER D ITFiV~I. ELEVATION OBSERVED a I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) • B- 1 7.17 99.00 none >7.17 .83bl.1. 1.83bn.sil. 4.50bn.c.s. B_ 2 7.17 98.70 none >7.17 .92bl.1. 1.67bn.sil. L1.58bn.l.s. B- 3 7.08 99.60 none >7.08 .1.08bl.1. 1.08bn.sil. 1.08bn.s.1.•3.83bn.c.s. B_ 4 7.00 96.40 none >7.00 .83bl.1. 1.58bn.sil. .75bn.s.l. 3.83bn.c.s. B. 5 6,83 96.00 none >6.83 1.25bl.1. 2.00bn.sil. 3.58bn.l.s. rB-- PERCOLATION TESTS ITEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p PERIOD PER INCH P P. P. P_ ee design rat P- P- PLOT PLAN: Show locations of percolation tests, soil borin and t e dimensions f suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show thei locati on a plot pl Show the surface elevation at all borings and the direction and percent of land slope. 93~ Q a d f~, SYSTEM ELEVATION 96• ~ t , VV, L UYI Imo' i5 ~'t ' l ~j f 16 34 6 po, i I r - - - - - _ _ .I - _ _ _ •J I I~ t1 1, the undersigned, hereby certify that the soil tests reported on this a !r Y~ accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location o h are correct t' be of my knowledge and belief. NAME (print : ( TESTS WERE COMPLETED ON: Gary L. Steel 2-16-92 ADDRESS: r,~) ERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. aVe., New Richmond, Wi. 3' 17 2298 7 -246-6200 COUj~)`~ tt, CST SIG RE: ZONIVGUFFJ,E DISTRIBUTION: Original and one copy to Local Auttrbrity, Property O 9 a d6 1I T' DILHR-SBD-6395 (R. 02/82) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS II~DUSTF,Y, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP9hVI!HVMALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NE 14SW ~4 31 /T29 H/R 18kr) W warren n/a n/a n/a COUNTY: 'S /BUYER'S NAME: AILING ADDRESS: St. Croix Troy Holm M 1521 Ward AVe., Hudosn, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: MAesidence 3 na/ 530ew ❑Replace 1 1-16-92, n/a RATING: S= Site suitable for system U= Site unsuitable for system II rDS ONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑U E ❑U ] S ❑U ❑ S ®U ❑ S EU trench If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 67 BxD2 BORING TOT,qq~~~ DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTF~N'r, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B_ 1 7.17 99.00 none >7.17 .83bl.1. 1.83bn.sil. 4.50bn.c.s. B 2 7.17 98.70 none >7.17 .92bl.1. 1.67bn.sil. 4.58bn.l.s. B 3 7.08 99.60 none >7.08 1.08bl.1. 1.08bn.sil. 1.08bn.s.1.3.83bn.c.s. B4 7.00 96.40 none >7.00 .83bl.1. 1.58bn.sil. .75bn.s.l. 3.83bn.c.s. - B_ 5 6,83 96.00 one >6.83 1.25bl.1. 2.00bn.sil. 3.58bn.l.s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PERIOEF PER INCH P__ I ee design rat P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96.00 I H i j I S 5 3 l(! 1 I E I i 1 O~ 1 I, the undersigned, hereby certify that the soil tests reported on this er~accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location o h are correct t be of my knowledge and belief. NAME (print): { 1aL, TESTS WERE COMPLETED ON: Gary L. Steel 2-16-92 ADDRESS: it jJ ERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. aVe., New Richmond, Wi. 17 2298, 72-246-6200 VO,9v_r OUNT( CV CST SIG RE: ZONING OFPAG_CE DISTRIBUTION: Original and one copy to Local Auth$rity, Prd S1~i11T DILHR -SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBO - 6395 To be a complete an(] accurate soil test, your report must include: 1. Comp fl description; 2. The use action must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or rrniac-=meat system; 5, Complete the it % rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 83 Make, sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, if the information (such as flood plain, elevation) does not apply, place N.A. it) the appropriate box; 1 1. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as rectuired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob Cobble (3 - 10") SS Sandstone gr - Gravel (under 3") LS - Limestone s - Sand HGW - High Groundwater cs Coarse Sand Pere - Percolation Plate need s - Medium Sand W - Wall Is Fine Sand Bldg Building Loamy Sand > Greater Than - Sandy Loam < Less Than - Loam Bn - Brotivn Silt Loarn BI Black si - Silt. Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl Silty Clay Loam mot - Mottles sc - Sandy Clay vv/; - with w s sic -il+y Clay fff few, fine, faint r~ cc - common, t _mrse pt turn -Many, r m P" d - distine., p - prominent HWL - High watei,level, Six general soil textures surface wal)er for liquid waste disposal' 4 BM - Bench Mark VRP Vertical Reference Point I a b n TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any Construction, a W.itona^ Deoa-ims-ri at it dustry. 'UIL UL ~t_ttlr' t tvr r nu vrt r labor and human Relations = U lo. '--4 (Attach Soil Profile Location Map - To Scale - On A Separate. Signed Sheet) r.ladrlon.:.I Page 1 L CVitp404ftU4 aoa IV -'19-"9 CVBlTINOUW VEO tANErI /"nt•Ir1MTEn Kd1'V"f.ECf rla00rW.1! 12 un lowed outwasi 1521 Ward Ave. Hudsori;YWi. 54016 !`"TE COMFY a 450~dp6~" St. Croix to"r 29 jig 18 ta+n+al~4'2i4L@C t11It.ARCEtM1..ER 1 SW 114 rr g~ r Cssal LOT n /a BLOCK n /a sUBolvislow n /a g NEW _ REPLACE B. 1 Horton Death Dominant Color Mottles Structure Limning Factorl LoaangGPO'se. n. In Munsell U. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary Depth Trench sod 1 0-10 10YR 3/2 none 1. 2/m/ab mfr 1/f C none .3 .2 Elcv = 2 0-32 10YR 4/3 none sil. 2/f/sb mfi 1/f C none 9.0 3 2 -8 10YR5/4 none c.s. 1/f/mg ml 1/vf C none .8 .7 Morison Depth Dominant Color Mottles Structure Urraang Factorl Loaonq.GPpsq M. B- 2 In. Munsell u St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary Depth Trench Bed 1 0-11 10YR3/2 none 1. 2/m/abR mfr 1/f C none ..3 .2 Elev = 2 11-3 10YR4/3 none sil. 2/f/sk mfi 1/f C none 8.7 3 31-8 10YR3/3 none l.s. 1/m/gr mvfr 1/vf C none .6 .5 13 . l Mortton Depth Dominant Color Mottles Structure Limiting Factorl LoadngaP6s4 h. 3 In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds Oepth Trench Bad 0-13 10YR3 2 none 1. 2/m/ak mfr 1/f C none .3 •.2 Elev - 2 13-2 10YR4/3 none sil. 2/f/skb mfi 1/f C none .0 .0 9.60 3 26-3 10YR4/4 none s.l. 1/m/sk mfr 1/f G none .5 .4 4 39-8 10YR5/4 none c.s. 1/f/sg ml 1/of G none .g .7 r n Laanq:4Pda0. R. 13 _ 4 (Hot ton Depth Dominant Color Mottles 'Structwe umin g Factor/ In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounda Depth Trancn sod 1 0-10 10YR3 2 none 1. 2/m/a mfr 1/f C none .3 .2 Elev = 2 10-2 10YR4/3 none sil. 2.f.sk mfi 1/f C none .0 .0 6.40 3 29-3 10YR5/4 none s.l. 1/m skb mfr 1 f G none .5 .4 4 38-8 10YR5/4 none C.S. 1/f/sg ml 1/f G none .8 .7 13- 5 Horton Depth Dominant Color Mottles Structure LImillnq Factorl L-dingaposd. R. In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundar Oapth Trench Bed 1 0-15 10YR3/2 none 1. 2/m./a b mfr 1/f C none .3 .2 Elev 3 none sil. 2/f/sk mfi. 1/f IS 10 .0 96.0 3 39-8 10YR3/3 none l.s. 1/f/gr mvfr 1/vf G re .5 1- 7 i Additional Remarks: RECOMMENDED SYSTEM TYPE: s' t eh page # 67 Soil series Bxn2 area is ads uate for a conventional type system, balance of property ire a mound systein to be installed care shout be taken to protect original area pl nt- plan nn hark other Site Faturel: 96.0 r>11.'. 11-20-92 (715 )246-6200 2,298 $ytlCm Elevation CS rgnature Oa1e Signed Telephone No. CST. Gary L. Steel 1554 200th. AVe., New Rich,ond, wi. 54017 CST Name (Print) City Stale Zip rte= /~s~E~L 3,c.cx~vl -7,0 a• ti 0 ~ ~o y,, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPXXXXMeALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NB 1/4S W 1/4 31 /T29 N/R 18kr) W Warren nn/a n/a COUNTY: iMUMS/BUYER'S NAME: 7 AILING A - St. Croix Troy Holm 1521 Ward AVe., Hudosn, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATI N TESTS: tesidence 3 na/ E&4ew ❑Replace I 1-16-92 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) DS EU S ❑U )E]S ❑U ❑ S ®'U ❑ S EU trench If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 67 BxD2 BORING TOTAL_ DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.17 99.00 none >7.17 .83bl.1. 1.83bn.sil. 4.50bn.c.s. B 2 7.17 98.70 none >7.17 .92bl.1. 1.67bn.sil. 4.58bn.l.s. B 3 7.08 99.60 none >7.08 1.08bl.1. 1.08bn.sil. 1.08bn.s.1.3.83bn.c.s. 4 7.00 96.40 none >7.00 .83bl.1. 1.58bn.sil. .75bn.s.l. 3.83bn.c.s. B- B- 5 6,83 96.00 none >6.83 1.25bl.1. 2.00bn.sil. 3.58bn.l.s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- P_ ee design rat P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96.00 i :F✓/ .its 5QI j o - r a 7-il . t~ I I 1 I, the undersigned, hereby certify that the soil tests reported on this ee accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location o h are correct t be of my knowledge and belief. NAME (print : I'Da t TESTS WERE COMPLETED ON: Gary L. Steel 2-16-92 ADDRESS: ri I ~t11~ jj ERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. aVe., New Richmond, Wi. V17 2298 7 -246-6200 COUidI'( CST SIG RE: C-~ ZONINGOFFIGE 6~ DISTRIBUTION: Original and one copy to Local Auth$rity, Property O `9 a d 6~i1 T DILHR-SBD-6395 (R. 02/82) - OVER - W.1tonsm oeoanr^Pr't of ir•dustry. ~UIL Ut~Litll' I lvta nt.I wit t Labor and human Relations I,= ~(Attach Soil Profile Location Map • To Scale • On A Separate. Signed Sheet) r.ta0ton... Page 1 ' L crsrac"rwa aoaav P9 rorrt~otaevtocwert rur WAt aao►wts.ser Rooo rsw+ae 12 unplowed outwasi 9. n/a 4'5_0 4 G'*_ a 1521 Ward Ave. Hudson, Wi. 54016 .rate ZIP eaear svsy St. Croix 450 sa~~ DORM 1 114 NE Local SW 31 29 1$ lowMS~~ XXK I uutr,Nea►uata t Unrrpn cslar LOT n a BLOCK n /a suBolvlsloN n /a $few _ Iteauee 13- 1 Norton Depth Dominant Color Mottles Structure Limiting Factorr LosangGPO•sq. n. In Munsell u. St. Cont. Color texture Gr. St. Sh. Consistence Roots Bounder Dsprh Trench Bad 1 0-10 10YR 3/2 none 1• 2/m/ab mfr 1/f C none .3 .2 etc" - 2 0-32 10YR 4/3 none sil. 2/f/sb mfi 1/f C none 9.0 3 2 -8 10YR5/4 none C.S. 1/f/sg ml 17vf C none :8 .7 Norton Depth Dominant Color Mottles Structure Lim-ling Faororr Loaang.6PDa0 n. E' 2 In. Munsell u St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounder Opth T.anch Sao 1 0-11 10YR3/2 none 1. 2/m/abl mfr 1/f C none ..3 .2 Elev = 2 11-3 10YR4/3 none sil. 2/f/sk mfi 1/f C none 8.7 3 31-8 10YR3/3 none l.s. 1/m/gr mvfr 1/vf C none .6 .5 a _ I Norton Depth Dominant Color Mottles Structure Limiting Factort LoadingUPDau R. 3 In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds Dpth Trench Bed 0-13 10YR3/2 none _ 1. 2/m/ak mfr 1/f C none .3 -.2 Elev = 2 13-2 10YR4/3 none sil. 2/f/skb mfi 1/f C none .0 .0 9.60 3 26-3 10YR4/4 none s.l. 1/m/sk mfr 1/f G none .5 .4 4 39-8 10YR5/4 none C.S. 1/f/sg ml 1 v G none .8 .7 B _ 4 I Norton LI_ Dominant Color Mottles 'Structure LIrMIIng Fatten LoaangaPD,ao. n. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds Depth Traneh Bad . 2/m/al mfr 1/f C none .3 .2 1 10YR3/2 none 1 Etev 2 10YR4/3 none sil. 2.f.skb mfi 1/f C none .0 .0 6.40 3 29-3 10YR5/4 none s.l. 1/m sk mfr f G none .5 .4 4 38-8 10YR5/4 none c.s. 1/f/sg ml 1/f G none .8 .7 .J I 5 Morison Depth Dominant Color Mottles Structure Limiting Factor/ Loa Ong0P6so• It. In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounder Open Tench Bad 1 -15 10YR3/2 none 1. 2/m./a b mfr 1/f C none .3 .2 Elev = 4 3 none sil. 2/f/sk mfi: 1/f C 10r'6,?ks .0 3 39-8 10YR3/3 none l.s. 1/f/gr mvfr 1/vf G e .5 Additional Remarks: RECOMMENDED SYSTEM TYPE: `s' t~" eh J page # 67 Soil series gxj)2 area is de uate for a conventional type system, balance of property ( ire a mound system to be installed care shout be taken to protect origins area ~plnt nlan nn hank Other Sltg Fealurel: 96.0 1-20-9215 ►246-6200 2298 System Elevation l:S tgnature^ Oslo Signed Telephone No. CST Gary L. Steel 1554 200th. AVe., New Rich,ond, wi. 54017 CST Name (Print) Cily Stele Zip IT 00' Ul ✓7714eA, e ,VIA o 110 ~S y 0 ~y p l-- 3' I s J. r ~ J. h. / to 433` 27 CERTIFIED SURVEY MAP Located in part of the the NE-1-4 of the SW; of Section 31, T29N, R18W, Town of Warren, St. Croix County, Wisconsin. ~I OWNER I Virgil Cernohous RR 3 SCALE IN FEET Hudson, WI 54016 0 100 200 400 Certified Survey Map o d 4 4.1 J~ U N Vol. 6, Pg. 1580 Small-Tract L -N00°38' 28"W 166' I gg0 24' 3611 5 6 2 - N w 123.00' r .529.34' o I 33.00' ` 3 Co -J I N V) L L - -589°00' )3"E d d fO Existing 14.43 Road L v o 4+ N LOT 1 C- 148.481 n E 8 90813211E 04 'S6n _ s N 1047.02 132.87, W - M v a~ I I o l0 I m o L I • I CD w ['7 + M I O I C I TI O I y ~ ~ I 3 1 4- W ~6J 3 f NWN I I ~ c0 I -N ~ (I Co i0 I 1 L I O I -O I O 'O I d I O 14- -If~ IV I O - I~ O 41 I CLI th f0 I c I !W 00 r\ I n 3 a I n Cr c I + L(1 0 _ } O I LOT 2 LOT AREAS: CD a ~I Fo N Lot 2 Including R/W: cY1~ 376,252 SQ. FT. rnl ,va 8.64 Acres a ~y 0~ Lot 2 Excluding R/W: 340,848 SQ. FT. 11 1-44.081 y 0 7.82 Acres 442.95' S89o08 326J 487.03' Lot 1 Including R/W: 6'I 195,960 SQ. FT. Small-Tract 4.50 Acres 'T£ Lot 1 Excluding R/W: LEGEND 186,835 SQ. FT. t 4.29 Acres L.1 ' a ; it wry . , w - County Section Monument e t.,• O 1" x 24" Iron Pipe Set, 9 0 weighing 1.68 Lbs. per, linear foot i X01 cou" ANNift oamwff U. S88054152'IW 1311.591 South ine o the SE4 of the jW of Section 31 S} Corner of SW Corner of Section 31 Section 31 VOLUME 7 PAGE 1933 This instrument was drafted by Fran Bleskacek Job No. 86-37-187 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /1'oy L. Ild//-7 a 3y / ROUTE/BOX NUMBER y~ / 5T FIRE NO. _ CITY/STATE ZIP 3 PROPERTY LOCATION: N15-1/9 1/4, Section 31 , T_ALN, R_zi_W, Town of Cr~r~ h , St. Croix County, Subdivision QOA-9__ , Lot No. Improper use and maintenance of your septic system could result in its premature failGre 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 for a MAXIMUM of $3000 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 systems properly maintained. The property owner agrees to submit to 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 form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 10 days of the three year expiration date. SIGNED 4r~iY A04 41.6 Ctd .1 LJYD DATE G/_ 16 92-- ~lD St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-9680 Sign, Date, and Return to above address S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property !'C y+ Z ~ X411 C,n III Z/1 s 4 Location of property~l/4 SvU 1/4, Section T, J` N-R I W Township IN~G rr~n Mailing address i Address of site 4&7-Subdivision name Lot no. Other homes on property? yesX_No Previous owner of property Pvsjg/ C~2 n7 - oyes ~r~ ; .T It Oil Total size of parcel L~o ~~rNs Date parcel was created Are all corners and lot lines identifiable? --/V--Yes No is this property being developed for (spec house)? Yes ~No Volume 7 and Page Number / y 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.--Y-arz/"~ own the , and that I (we) presently 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. y , Sign ture of applicant 4o-Uap`p11-jc-ant Date of Signature ` Date of Signature DOCUMENT 1,10. WARRANTY DEED TNIS SPACE RESERVED FOR RECORDING DATA , , STATE BAR OF WISCONSIN FORM 2-1982 478779 REGISTER'S OFFICE St. Paul Postal alployees Credit Union, (a ST. CROIX CO.,, WI ...............Ntirire'sota corporation Recd for Record FE B Q 41992 °t 11:00 A. M conveys and warrants to .....:..:arid::sa::A:::~Io7m;.........•.... husband and, wife Register of Deeds RETURN TO w the following described real estate in .......St-.Croix County, L~ State of Wisconsin: t Tax Parcel No: Part of the NE ;4 of the SW ;4 of Section 31, Township 29 North, Flange 18 West, Town of Warren, St. Croix County, Wisconsin, described as follows: Trot 1, Certified Survey Map, recorded January 14, 1988, in Vol. 7, page 1933, as Document No. 433727. qr' ` *T f Q (i F~ 1 REGINA E. PUGH is not NOTARY This homestead PUBLIC -MINNESOTA property. (is) (is not) RAMSEY COUNTY . 'k,40., My Commission Expires Feb. 15, 1996 w Exception to warranties: a4aoR•"Dae:as easements, restrictions and rights-of-way of record, if any. Dated this .................31st....................... day of January.................._......................., 19..~~... (SEAL) ~1~... (SEAL) ° * ...'!:._..llQ._......... (SEAL) .....(SEAL) • * .....`GG,.-'~'L........ AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF 1,^. ISCONSIN 3.6. ss. ...................County. S4 authenticated this ........day of 19...... n Personally came before me this :3 Z...-...day of the above named ohn G L_enar V.P: of Loans . . OF..WISCONSIN..... TITLE:.MEMBER STATE.BAR. . Brian ta: Sherrick; •~o7'iectiori- Manager- authorized (If by 706. Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY . Itristina Ogland .0 ...Attorney at.mow -Q-j~.✓.. ...-r-..~....................... Hudson-41--5)-4.01.6.................................. Notnry~ubiic County, (Signatures may be authenticated or acknowledged. Both My Commission is permanen (If not, state expiration are not necessary.) 2 t date : 19. I _ •N.mcn of Persons sianin¢ to nnv ennse-if.v should be tuned or printed below their siRnntures. -