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HomeMy WebLinkAbout020-1365-03-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: P.C. Collova Builders, Hudson Township CST BMElev.:- ~ Insp. BM Elev.; BM Description: 2v1 L ~ ~ ~l ' - - N 160 . QO . o g rvl. 1 / Cs C z. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~92 P-•e~~S a.~p Dosing - '" - Aeration Holding ^``---- TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic -~ Z p' NA Dosing _.--- NA Aeration NA Holding - -- PUMP /SIPHON INFORMATION _,..... Ma turer _, _. f7emand --_.. Model Number ~ _..-.---~~-""~ GPM TDH Lift ~ L Iction -'~ stem TDH Ft For ain Length Dia. Dist~Tov"'7ett-- ELEVATION DATA County: St. Croix Sanitary Permit No-: 363950 State Plan ID No.: Parcel Tax No-: 020-1365-03-000 STATION BS HI FS ELEV. Benchmark - 6 S- os, b ~ ~ • O Alt. BM ~, S p ~v Y I r BIdg.Sewer ~O,`(-o 9,Zs-~ St/Ht Inlet '~.~-O gg,2s"/ St/Ht Outlet ~,fdZ ~~.,$3' Dt Inlet ~- -- - Dt Bottom _ ----- Header /Man. q. 8 0 ~S, 8.~r Dist. Pipe- ~'S© ~S•$~ Bot. System ~`'` v\e-jffn '~ ekc.e.-s~ I l• 2~ t • so Fi~lGrade j 3 ~_3o q$•3 St cover ' f . o' j p /, bs _ .~ S• SOIL ABSORPTION SYSTEM ~~ ~1 ~ Qru,,e.~rc. ~ne,Y ~.. ~,~ TRENC width r Lent ~ ' ~ N Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME I N 3 }"S • ~ DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manu actu r: ~~ S~ ~ SETBACK ~ INFORMATION Type O r , CHAMBER Mo a Number. System: tJ. =~ ~' 3(~ `__ ~ OR UNIT - a.Li DISTRIBUTION SYSTEM _ v Header / ni old N Distribution Pipe(s) __~ .-1___ x Hole Size x Hole Spaci `g Vent To Air Intake Length ~~-- Dia. /~' _-. Length Dia. Spacing ~--•~~---" y ~{d SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed / Trenth Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) , Inspection # 1:01 / - `~ / OD Inspection #2: / / Location: 636 Todd Lane-fudson, WI 54016 (SE 1/4 SW 1/4 10 T29N R19W) - 1029192163 Riv~erpar~k Meadows -Lot 3 1.) Alt BM Description = ] °P ~ ~^-.~°'Q1e`^ ~n.'~'- ~e.~.~e~-. ~~tn ~j b .:~'~(1~, ~.~~. ~_. ~ ~' 2.) Bldg sewer length = 20 •~ _ ..-~-.~r,, -amount of cover = ' 36 ~~ ye' (``'~D~ ' 3~/ ~j ~~~ Plan revision required? ^ Yes ^ No //~ p - Use other side for additional information. 4' 2 v0 ' SBD-6710 (R.3/97) Date I spector's Signature Cert. No. I C7 y O ~ ~ ~ ' ; $w! I I n d _ co m ~' o o w l ~ ~ O O ~O ( 5. 5. ~ iD' 7 7 ~ cwo ~ 1 \ O. F3 N U (7 0 N ~ N a- 7 Q ? ~ < l o~ O ~ to c c ~ ~ 3 ~ W c N ~ a ~ ~ c~ ~ m 1 ck = yy c. ~ '$, co ~ ~ N N 3 a ~ Q .. o o rn ~ ~ ~ I A p < ~ A ao ~ 1 o c I O ~ O I ~ ~ ? O ~ ~~ N ~ n C O y p ' ~ p ~ c '~p ~ d ~ ~ ~ N a ~ O <D M I o ~ .. Z O D ~ I o 3 g ~ v I ~ ~ ~ ~ Z1 c I w N $ ~ c0 N n ~. a o ~ d ~ I ~ ~ ~ ~ v ~ ~• o ~ ~ C I ~ ~ c a I ~ ~ a w w I z I w~ $c~~o a mo y y'no a ~ ~ o ~ z c ~~ ~ O ~ a .. y 8 7 y ~ » O ~ ~ O ~ dOfD ~ ( D ~ M Q f C . N y. O . ~ ~' N N ~ (1D I ~ ~ ~ N ~ ~ .Z I d m 3 I ad ay y n ~ ~ . D ~ f S(G ~.~ fD I ~p((pD o , o l ~ f D ~i O °o ~. 3 ~ c c ~ ~ '~ ~~I J 0 C O N IV Q CO ~ ~ ~ Owl t0 ~ p ~ O w b o $ ~p O C 3 :'! Q ~ ~I w ~ m m N a -• Z to ~ .A i.1. p Z O J m ~ o Z A ~ A d m H! K ~1 ~• O ~• 0 ~• A O~ A 0 N O V ti b ~° dQ N ~ N ~.r ~p a Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of~ Division of Safety and BuNdings , in accordance with Comm 85, Wis. Adm. Code ~ county C ~d t Attach wmplete site plan on paper not less than 81(2 x 11 inches in size. Plan must include, but not iimfted to: vertical and horizontal reference point (BM), direction and Paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print aJJ Jnformat-on. Reviewed by Bate Personal information you provide maylse used forsecondary purposes (Privacy Law, s, tS,04 {t} (m}). Property Owner Property Location .{.. D I Govt. Lot s E 114 ~ 114 S fd T Z ~' N R/ ~' E (or~ Pro arty Owner's Mailing Address L•ot # Block # Subd. Name or CSM# 3 ~ ~ d wS Cityy State Zip Code hone Number ^ City ^ Village [$Town Nearest Road w (y ) d car C [e~ New Construction Use: f~ Residential / Number of bedrooms 3 "'~ .Code derived design flow rate ~ [~ [,~_ GPD ^ Replacement ^ Public or commercial - Describe: Parent material Flood Flain elevation if applicable n• :General comments S"ySJ~ am t jL ~. ~J Jam' ~d ~'n and recommendations: ~ ~,7<, G r.k ~, 9~`, ~j Cr,,,,~,,,r,~-(oc ~e-s~ int- d- © ring # ^ Baring ~- P;t Ground surface elev. ~ ft. Depth to limiting factor r~ .s~ in. Soil lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots P b/ft? p in. MunseU Qu. Sz. Cont. Color Gr. Sz. Sh. "Eft#1 "Eff#2 o~/o c r3/ - L h L, v , ~ , ~ 3 -~o ~ -- gas s 1 c - . Z -- ,~ -- - . -~ ~, z Boring # ~r Boring L~Prt Ground surtace elev. ~~~„_ ft. Depth to limiting factor ~,~.,_. in. Soil A licatian Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fi? in. MunseR Qu. Sz: Cont. Color Gr. Sz. Sh. 'E~#'I "E~2 -(~ eh ~ SG., f9'Xa'~.- YJ'l~r . So ~ o ~ ~... ~ a os ~ c i z yo~l,6 ~ ~ , -? ~. 2 ;3. ~•`.f ' Effluent #1 = BODg > 30 < 220 mglL aria ~,s >su < ~ ~ mgru _ Gmueni ~c = atru5 _ ,w ~n~r~ arn~ ~ a~a ~ ~v +~iyr~ CST Name {Please Print ~ Signature ~ / ,CST Number Address Date Evaluation Conducted Telephone Number 2~~ ~ ACS f_'? S~f'_ .~i~Y~.,cr,,y e ~- G,,,rl ,~'`7`G~'S-- ~.. ~ -{i~! ~i.:S ~~?~-/7- ~li~/~ ~Pr-op-er~ty Owner ~C~I IOJG I ~7 1 Borino # ^ BO~ng n.-~ ~ Parcel ID # //. ~l Page ~ of ~~ ~~ Ground surface elev. 7 7~ G5.3 ft. ueptn to uminng racxor ~ ri ~ ~~• SOii lica6on Efate i li De th Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPDffF ~on or p in. Munsei! Qu. Sx. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 { !~4 r Z ~ , ~ cr / G t ~ !/ 3 y to r3r~O "" s G ~ /, z to ,. `~ -- r 7 1. Z a,+ 7~. r (o ~ t -- n $ortng # ' ^ Boring / ~ J ^ pit Ground surface eiev: r. ueptn to umiang racror . rn. Soil Bcation Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP Dlff in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 Boring # ^ Boring ^ Plt Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mansell Du. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 * Effluent #1 = t3OD, > 30 <_ 220 mglL and TSS >30 ~ 150 mglL "Effluent #2 = BODg <_ 30 mg/L and TSS ~ 30 mglL The Department of Commerce is an equal opportunity service provider and employer, if you need~assistance to access services or need material in an alternate format, please cantact the department at 608-266-3151 or TTY 508-2648777. SBT)-8330 (RO"!OC) PAGE_3 OF~ `NAME C d I ICL 1~, LOT# 3 LEGAL DESCRIPTION S~ '/aSw~~4 S /D T2°[,N R jj E (or e 5CALE: 1"= l~~ ~ BM 1 ELEVATION /~' ~ ,_=~ ;. ., , BIW1 I,DFSCRIPTION ~~. ~~ ~~¢o pis' l~` ~-- ~ t ~ ~. ~ BM 2 ELEVATION 9' Fl• YS... _ ~a BM 2~DESCRIPTION ,4~~p'euC ~L_'g~ye ".~.'~1~_ Y SYSTEM ELEVATION ~S, S~ ~~ ALTER?~TATE ELEVATION ~s: ~~ ~ , r~nN~-nr ra Fi FveTinir '..r1/~ 4 O ~ ~ _ _' ~~~ ~V ~_~y_~ ~~~ ~ s~~~ ~ ~~~ c o-~~ _,~~~~ -~ `.- ~~ 3 0 I~r~' ~~ ~ 5~~ '. ~~ ~~ r- ~a ~ C,~y Co • `T ° ~lo~ J ' / ~~~ N ~~ ~ .~ NQ (~ P. ~-- ~ s 2a ~ ? t5 a ~ .,. ~~,' I --- ~M1L '~' ~,\ ~--,sJ ~. f .^~ ~ ~ --~ ~~ti -~ ~' ~ _ __ ______ ~._--~. - ~~NNIIN~N^ -- rrrri +.;. • 1 - - October 30, 2000 P.C. Collova Builders Attn: Laurie Collova 705 Country Trunk E Hudson, WI 54016 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Fax (715) 386-4686 RE: Septic Inspection for P.C. Collova Builders located at 636 Todd Lane, Riverpark Meadows (Lot 3), Hudson Township, St. Croix County, Wisconsin Dear Ms. Collova: A septic inspection of the above referenced property was conducted on 8/31/00. This property is located in the SE 1/4 SW 1/4 of Section 10, T29N R19W, Riverpark Meadows (Lot 3), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, Kevin Grabau Zoning Technician /sm cc: file ~_ ~ , Sanitary Permit Application Safety & Buildings Division Wis. Adm. Code In accord with Comm 83.21 201 W. Washington Ave. ~~ , See reverse side for instructions for completing this application PO Box 7302 ~~~~~, Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 department afrGammerc+a (privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach tom lete lans to the coun co onl for the stem, on a er not less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number ^ Check if revision to previous application State Plan L D. Number S?~c~a r' 3 I. A lication Information -Please Print all Information Location: e Property Owner Nam Property Location / / / t!. L O ~G~ U~ ~u r'~GC 1~. / $ ~r 1/4 S(~1/4, S d T~ N, or QW Properly Owner's Mailing Address Block Number Lot Number 3 C s N City, State Zip Code Phone Number ame or CSM Number Subdivisio a~ ~ G `' Y - ~7 ~rUey asp f~ e s II. Type of Banding: (check one) d ~~ ^ ~'ty ^ Village rooms : ^ 1 or 2 Family Dwelling - No. of Be ~9.TOwn of ^ Public/Commercial (describe use):_ ~ ` ~ S1 'J ^ State-Owned ' ~' Neazest Road dN ~ Pazcel Tax Number(s) 6 ~ -.~ S - ° ' r III. T e of Permit: Check onl one box on line A. Check box on line B if a licable i0 . Z ~ 9. Z / 6 3 A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to S stem S stem Tank Onl Existin S stem B) Permit Number Date Issued ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) ~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- ade ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Information: Z ~ r~ S r 1. Design Flow (gpd) 2. Dispersal Atea 3. Dispersal Area 4. Soil pplicati n 5. Percolation Rate 6. System Elevation 7. al Grade ) (MinJinch) ~ ~'f.~~ levation ft l Jd / R G . a s ay sq. ate ( Required Proposed VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ^ ^ ^ ^ . ~ ,,ff Q~v / ( r e t .Y ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS sho n the attached Tans. Plumbers Name (print) Plumber's Signature (no stamps): RS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) 1~~ C / IX. County/Department Use Only ^ Disapproved Sanitary Pemut Fee (Includes Groundwater Date Issued Issuin gent 'gnature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) ~ i . i -" Determination Z Z X00 Disapproval: ' X. Conditions of Approval /Reasons for / / , ~' ~i/{Cr ~ ~~ nutrn~RrnBLr" ~e~ l~tG~ttrt`~ G~4i~-s /l~onlvtt~.o{G~irw~-s 1 c ~ ~r' /oa55PG~ ~ z<D ~w~cr~~ GWr1 irn ~-or~<cl.w~ '~D !t't~irn~on.at•, t~ ' l / ....r„ /,,,,~ ~. rev t s ~ ems. ~' ~~ ~~ , /tJew c ~ ~ c ~ ~ ~-Qa..~ tU. `.1,1,5 1n0.t~~~"~" ~ ° `"~-r~ ~.Q"C` i p•H,~ ~ 1 ' T'a {~LL6~ • ,..~ r } ~~' p 1 2000 o si caax u, COIN F1GE ZOMINGOF _ 0 30 ' w-sconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of,_,~ Division of Safety and Buildings m accorvance wain vv ~ h~ i~"~~ j ~ County ~ td C 1 mtist'~- t l tha 8 1/2 x 11 in ~ e PIaa it Att h l t l ( t .a ~ . . ~~ an on paper no ess n ac comp e e s e p ~, r~ include, but not limited to: vertical and horizontal reference p ), ecttaMran ~~;~ percent slope, scale or dimensions, north arrow, and locati distarif~~~t road':; parcel I.D. ~~ Please print alt informati Il:~ eviewed by Date AA ~~1r i Personal information you provide may be used for secondary pur (Priva~y1~"~w, ~15f04 /~~)). Property Owner P Locati ,tom .+. O ~ i 1/4 ~ 1/4 S /~ T Z ~' N R ~ Q' E (or~U Pro erty Owner's Mailing Address Lot # ~ Subd. Name or CSM# a ~ •~t ~ w s City State Zip Code Phone Number tty ^ Village [Town Nearest Road (~ New Construction Use: ® Residential / Number of bedrooms ~ "`~ Code derived design flow rate ~/,~~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material Flood Plain elevation if applicable ft. General comments SYS14t r-1 •C. ~t y ~ ~d ~/~ %~. and recommendations: ~, L•?L • C (.Q ~.. 9~~ ~~ .~>-~v`-. C ~ (1~-~. ' ~ Boring Boring # ~!t Ground surface elev. 9 ~. SStl ft. Depth to limiting factor l ~P in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 b -(off ~ -- (ras S ~ C ~' . 2 ~ y - s - - .-] /•Z Boring # ~ Boring [~ Ground surface elev. L•~.~ft. Depth to limiting factor ~[,~f!p in. Soil lication Rate .Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPR/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 -~ 6 /z --- SG- ~~ sn~~ ~ . y . ~ z ~ l~ r -- ~s ~ -- • 7 ~• z. -°yo ~ ~ -- a.S cos Pn C - / 2 * Effluent #1 = BODg > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and T55 < 30 rrxl/L CST Name (Please Print Signature CST Number ~~~ s~ ~~ak~Y ~~ zs~~Gy Address ~ Date Evaluation Conducted Telephone Number zii 3 ~-a ~ s ~. ..5~ ~ ~-~s ~ ~- w / Syc~z.S~ ~ G -~c~ 7~s =z ~i~ - yo~~ Property Owner CU~~OtJC~ Parcel ID # Page ~ of Boring # ^ Boring [(~ Ground surface elev. 9p. Za ft. Depth to limiting factor _/l ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, *Eff#1 *Eff,#2 3 y- to ~3~G `- s G - /, z a LO / .-- , 7 ~ Z I „_, I L~ Boring # ^ Boring ^ Pit Ground surface elev, ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BObg > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD~8330 (R.07/00) I r 7 PAGE 3 OF~ NAME C 4 I'n ~ IGc LOT# 3 LEGAL DESCRIPTION SC '/aScv'/4,S lO TZ°~',N,R l q E (or~ scALE: I'°= SOU ' BM 1 ELEVATION /OU ' v BM I DESCRIPTION ~eP Q„~ -1z~~~oP~oc r p: ,/.1~ BM 2 ELEVATION q ~• yS~ BM 2 DESCRIPTION y6po.~ ~,~C¢apD~P~ ~~ SYSTEM ELEVATION ~ S- O d ALTERNATE ELEVATION ~s ~ ~d CONTOUR ELEVATION i(/~ • -G -mod ~- - ~ f`'~N L`'crl/cr L°"~- /J!, ~~ /i[ t' y~ /~ a r ~ /i ,'yt'tr /~''atY'f( /71 Cx! ..L' Cr:+•~~ ~v-c ~'a/sJ 'Y i~~~ ys, o e v~ c;~S ~~ i ~\ 3~ v Q J ~'~~s ~bF~ ~~~ k~` ~ ~~~ ~ ~ .s ~gi~ ~~ ~l~ L V T '`" 5~~~ ~ ~ /~+J~'S~f` ~I '~ ~' ~ .~ ~ __~ l ~~ G~ :~ ~ ~ Wisconsin Department of Commerce SOIL AND SITE EVALUATION ` Division of Safety and Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~ . ('~-o\ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pa~,,oi , n ~ Page ~ of APPLICANT INFORMATION -Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). / '~ ~~ Property Owner Property Location ~~ - ~ Govt. Lot 1/4 1/4,S T ,N,R E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Ciiy fate Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road Nulls ~ of <~1t5~5 -~ ~~ lei. ~~, [~ New Construction Use: Q~ Residential / Number of bedrooms ~-`! Addition to existiny building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow l~Ul~ gpd Recommended design loading rate • , bed, gpd/fi2 o trench, gpd/fly Absorption area required g~1 bed, ft2 ~ ~L trench, ft2 Maximum design loading rate bed, gpd/ft? ~ $ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~~ . ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations 14 L-1•. ~ tev. ~{ ~, O C~ Parent material ~l1 ~ t~.~Ct~h Flood plain elevation, if applicable IV ~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system [~.S ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ® U SOIL DESCRIPTION REPORT Boring # Ground elev. 9o•'f~cs ft. Depth to limiting factor ~' in. Boring # 2 Ground elev. 93,ZUft. Depth to limiting factor ~_in. Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry , T ~ C>- !U ~ 3~Z S ~ i 1 ~bk tY1~r C,5 ) U . Z ~ - 3 Z 4-30 • /0 ~ yly --~ s; I 2 rYr~.blc, m~'~ c. - - 5 ; - 3 ~-~ • f r X11 co - m s os cs _ ~ ~~~ ~ _ , +~ ~'~ Remarks: ,',~. << x r , F ~A Z /328 t0 ~ `-1 ~ 5~ L 2 ~ ~s - ` - ~ ~ ~ t~ ZYl 'lcv' • IC.J a ~'~ 5 L1S ;~~ ~ ~ Ue'~ ~'L '` ~ O r - _ l~. j . ~ ,~r - , ___i_.~. . , Remarks: ;ST Name (Please Print) Signature Telephone No. Ado,n~ S ch er c ~ - -----_-- `1 ~ ~ - y - yC~ 8 4ddress Date CST Number ~-i. b8 ec~1~r # y S t 5`I a ~ 1 !- 8- `f 9 253309 r SOIL DESCRIPTION REPORT PROPERTY OWNER ~ ~ (._( ~) UG( Page ~ of PARCEL I.D.# Boring # '~ Ground elev. Cf /, S ~o ft. Depth to limiting factor Ia-I in.~ Boring # Ground elev. /.Z(o ft. Depth to limiting factor ~bl~ in.- Boring # .~ Ground elev. ga~tt. Horizon Depth Dominant Color Mottles Texture Structure Consistenc Bounda R ts 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. e ry oo Bed ,Trench f' n Z ~~_y ~ I ---- s~ ( b~ - ~ - - 5 3 y~-it~l I ~. r ~~ to - rY~ S ~ VYl I c•s - . 1 ~ . 0.~ ~- ~ ~ ~ , 3t ~ . 5 ~~ ~' 3. S , Remarks: I ~~+~ ~1b r z ~ ~ Ivy .2 ' .3 3 Z(o -~co • i ~ ~ - 5 v ~ ( L ~ . 1 ~ . ~ a, ~~ , Remarks: Horizon Depth Dominant Color Mottles T t Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ,Trench ~ _, - ip 3Jz -- 5. ~ k m~~ ~ ~ ~~ .2 ~ . 3 3 - o ~D r'- Irp -- os ~m1 ~5 ~ . ~ ~ . 8' Depth to limiting factor , /d/ in. Boring # Ground elev. ft. Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) r '~ -r - ~'~~ SCALE 1"= ~U DESCRIPTION-ToOo-C I'puc(1.'Pe ~ BM2 ELEV . 9~; oa DESCRIP~TON~-7'o~orl~P~-'.°-e SYSTEM ELEV . ~S S.. (o ~° ALT. ELEV. ~ ?, oU CONTOUf: EL• EV . -'l v r1 2. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND' OWNERSHIP CERTIFICATION FORM Owner/I3uyer ~. ~ . (b I ~ oV'A g I ~ rt S ~N c._. Mailing Address ~O~ ~~~ • ~t d t /~v4su-v (,v L. $'~}-v 1(,~ Property Address ~0 3 (® ~o d d. ~ N' ~. (Verification required from Planning Department for new City/State y~.~~ W~ Pazcel Identification Number (~~O 1.~~~ 0 3 C~OC~ LI~:GAI, DESCRIPTION Properly Location ~~ %,, Sly y., Sec, 1(5 , T~N-R~W, Town of ~~ds~ Subdivision _ Rf U ~2QA2~ ~EA-Oc~~y~ Lot # ~ Certified Survey MaP # Volume .Page # Warranty Deed # w fo ~ (~ ~ Volume ~~3 9~, Page # ~S L , Spec house ^ yes~no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature.failure to handle wastes. Proper maintenance consists of pumping out We septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in We waste disposal system, The property owner agrees to submit to St. Croix Zoning Dcparhnent a certification foram, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumberor a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), We septic tank is less than 1/3 full of sludge. Uwe, We undersigned have read We above requirements and agree to maintain the private sewage disposal system with We standards set forth., herein, as set by We Department of Commerce and We Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to We St. Croix County Zoning Office within 30 days~o€-tlifej.~iluee year expir,~tio~n date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) We owner(s) of the perty cribed above, by virtue of a warranty decd recorded in Register of Deeds Office. /, ~_ , ~ SIGNATURE OF APPLICANT DATE ****** Any information Wat is mis-represented may result in We sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from We Register of Deeds office a copy of the certified survey map if reference is made in tl~e warranty deed %Y STATE AiR OF W15C.DNSIrJ FOFM 2 - 1562 606267 l4AA.RAh'FY DEED .t ,}rTry q 1~~ ~ v~ P KA7NLEEh1 H. YdLSfI kEOISTER 0p DEERS L?[ CROIX CO 5T l)UCUMENF NG. r G, 1 JiJ ' . T , aECS:r~En xoa a~ctx4 -„ ~3~Mat~arie Halernee t Frances Augultt and Paul ti8tner 07-05-1996 9:30 AN ny tanan a n cumsnon -'"""""_'-' a k/a Francis RAdil 6EFD •- August f P T FFEt 4 CERT _ canvr;a And wstrtr,ls to ~ • n_ ova u cera, Ino. t a .lttscoltsln Corporat~cn~~ - ~ t:4pY EEt ~RR~~W7SFEA FEE! 1310.10 1}ID fEEo 22.44 S ' PA !9 i:, - t --~ - Told s+ACa nescnvso roa nceonau:o aAT, the bnnu'+ng dsscriUnd :gal earn '.n k,• ra x LuLnty, C'AVIt ~ v• GS 1 RE~.:~ 51a:a v[ w'tsccrlnn: $[}Q 1. ~1CU57 T. SL 1/4 9b,' 1/S Sec. 10-T29N-RL9W excepting therefrom LoC ( ~'~UDfi'CJN, ~ ~~~'-' of Certified Survey flag recorded in V01.7 of Certified SurvCY Fiapot page 2089 ae Uoc. No. 4r730Jr also excepting OZU-1010-20 the rallrcad right of way, Q20-]02~:90 020-1025-90 ttE 1/4 NW U4 Sec, 35-T29N-R19W excepting thaCaftcm !at ! PArccu uu I •it•iuvwMe'-"'-€a '-""" of L'artified Survey Map recorded in Vol. IO of Cortified Survey Mnpct page 2701 sa Doc. Vo. 5C7718. ill) 1/4 NE 1/L Sae. 15--T29N-AtSiW 71ria is not bumaxatd property. --141.- {stloJ Exception ro wArrsnues: iy~ Dated thu ___._~ day of Juna ,„„_.. f g 99 . ~ (Sf:AIJ Paul aatner Si6ntcues).....~__.~ _-_-...r.~_ a:uhepdaled Ofls dsy of , :4, FITL?: NEb!BER SIAIE tSAA OF W15CONSIN tl! nut (SEAL) ;~ ACKNOWLEDGMENT •~ Stalc of ~~~se~~,°n SLrE nITACHED~, EY.ifIBIT ~rArr ' King Caurcy ~. fetsorl:y carna bcfure see dux 25th day v! Juno 19 99 . 111a aho,~c nanstxi 1 t 1<ranaou uguat __ I aWhori>:td by f 706.(/8, Wis. &xs.) so Ire Y.nuwr. to b ~e ptcsen -"' who s~ecvtas! the ft;regotrg insl t sr cl n Wledga t~rla. Tr118 IViTQUMF,NT 'JAB ppA:TQ6 P~~~„~• Heywood 6 Crtc':, 9.C. by 1ialtor 1lodynak 104 LocueC Sti.. 4.0. k1cA l25 Ku sons HI 5401NmaryPublic. R na ._..•__....._Cannfy.~p~ (SidrA~C'ta utay b~:aY:f:U nISCMltt ar aaknaw.edgld. aat11 an! n01 bty euautliu{on fc pennmen:. 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