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HomeMy WebLinkAbout020-1349-12-000l"'~ '~* ` 1• Wisconsin 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~J5.04 (1)(m)] Permit Holder's Name: ^ City ^ Village, fl T,gwn~~onfSlli Delta Construction, tiAQS7)Tl 1 O p CST BMElev.:- Insp. BM Elev.: BM Description: od TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~6~5 ~ ~ Dosl Aeration Hol ~ g TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic > 3S'/ > ~S~ Z2. ~ 7 ZS'/ NA Do ~ NA Aerati olding PUMP /SIPHON INFORMATION M nufacturer Model Num TDH Lift Lriction Forcemain Length Dia. Demand TDH ELEVATION DATA county St. Croix Sanitar~ /~F7Z50 0.: State Plan IDyNZSO.: Parcel T~xAlo1~349-12-000 STATION BS HI FS ELEV. Benchmark Z.(~/ oz,G Gd vo_ Bldg. Sewer ,[~/~ 9~- St Ht Inlet ~, , ~' ~ Ht Outlet , Header /Man. 9' Z Q~ , G Dist. Pipe c R /u. 00 9 •G/ Z'G Bot. System ~` ~~' a ° p~, y~ Final Grade r ~S- ys- t cover ~/. S' 1~r SOIL ABSORPTION SYSTEM // , / ._ ~ _ ,_ _~ BED / REN Width Len No. Of Trenches PIT No. Ot Pits Inside Dia. Liquid Depth DIME N ~ ~ Z DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM L of j er: SETBACK INFORMATION Type o ,n ~~( P ~ / ~ ~ ~ ~ ~ ~'sr `'~~ CHAMB O NIT Mo Num er: / System: (o y ~ ,~ DISTRIBUTION SYSTEM Header / Manld Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~/ Length ~ Dia. y Length~~.S Dia. ~ Spacing ~ /V 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 /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~ /Z1/4/ Inspection #2: / / Location: 747 Blue Jay Lane, Hudson, WI 54016 (SE 1/4 SW 1/4 26 T29N R19W) - 2629191888 Browns Ridge -Lot 12 1.) Alt BM Description = s%~ o~ -~„r~,~" ~oo~ c/) ~,er~ Q ~, -~~; ~ -~O S~+N Ke,,~ 2.) Bldg sewer length = ~. y' t /t' -amount of cover = ~/f" j~ ~ Gis,i~„yj~~ ~S ~ ~ S`f°t' a~ - ~.) ~ / {~ J r h `~ Plan re sior(;requlr~ ed'~ ^ Yes ~ No Use other side for additional informs ion. ~~ 6 SBD-6710 (R.3/97) Dat Inspector's Sign ure Cert. No. .. < ;, ' Sanitary Permi Application Safety & Buildings Division ~ In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. ~ ~ ~~ See reverse side for instructions for completing this application PO Box 7302 SC~~.~l,n Personal information you provide m or secondary purposes Madison, WI 53707-7302 Department of Commerce [privacy L ~~ ( ( (Submit completed form to county if no' state owned.] Attach com lete tans (to the count co nl r the s st m, oily of less than 8-1/2 x 11 inches in size. County ~, to previou application State Sanitary Permit Numb I •:, ^ Che if State Plan I. D. Number , `~~ 3 ~~ s I. A lication Information -Please Print all Inform Location: Property Owner Name ` 1 r ~~~~ t~; _._r Property Location r ,ti _- _ ~ S 7 ~' ~~~~ ~~ ~~ ~ ` .~~ 1 /4 1 /4, S.f T N, ~ (o t_ ~ ~ Nu Property Owner's Mail i n ~; g~A ress ~ : - t -ONi,VU C)~;.,r~ Lot Number lock mber A ~ ~ " City, State Zip Code o e b ivision Name or CSM Number Su b d ( ) ~~ ~ l ~ /.>/~O~GfJ/(~ II Type of Bui ding: (check one) ^ City 1 or 2 Family Dwelling - No. of Bedrooms: 3 ~ ~ t Per P ~aw5 f4 6,,K ~ {fr/ ^ Village ^ Public/Commercial (describe use): Town of ^ State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road G t p) 1. f~New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Nu bey s) sts-t 3 y' - (z - sao S stem Tank Onl Existin S stem B) Permit Number Z ~ - Z- ?- ~Q, !~~' ~ Date Issued ^ A Sanit 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-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersal/T'reatment Area Information: Z Z e ~ 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals.lday/sq. ftJ (Min.finch) Elevation Sly ~ 3T~~ ~ ~ i.. ~ pi. ~ ~'~ o VI Tank Capacity in Total # of Manufacturer Prefab Site teel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit for installation of the POWT own on the attached tans. Plu tier's Name (print) Plumber's Signature (no statrlDS): M~PFMPRS No. Business Phone Number /~. ^ ~- I*~ 0 6j ~- rid Plumber's Address (Street, ,ity, State, Zi Code) ~ 1 ~ ?r r 8v VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) l~ Approved ^ Owner Given Initial Adverse Surcharge Fee ) Determination t ~P Z Z , ~C7 q~ / 2. LO d IX. Conditio ~ of Ap royal /Reasons for Disapproval: / ~ U `i~lAar1l'4.n P~ /~ 4 kt'CGTu rtr5 r~Lalnn'sk'dt7~~o, z J ~~~~c 5~.4(( !per ce~t~~a:.~~ /`oof~n, ~r rcP (Qec ~-.. ~n,t ot~-S r~~ of ~ SBD-6398 (R. 07/00) ..~- ~ ~ ~' v ~ ~ w ,'~!t c ~OC1 1 d .~ Y 3 r> \\~. _ lV \ ~ ~ t, ~~ ~~ ~ ~ ~ . o N~v~ ,~ o ~ M~ S ~~~~ ~ NN ~ O~ 0 p `1 ~ V ~ ~ ~ ~ ~~ ~ ~ N9 V ~ ~^ ~1 c h ~I ~ 1 ~ ~ ~ ~ ~ ~ ~ ~ ~~~ ~~ ~ ~~~i~,~s~~ 1. ~ ~ ~ O + ' x~~o ~ ~ ~ ~ ~ ~~ ~ ~ ~-' 1 ._.. - _ -1 --- -- -- ~ `` N ~: } s ~ ~ ~ J r '^ ~ ~ . -~ T s ~ M V .I. t .. -- -- ~. ~- ~ J \\ J ~ ~ ` 3 ~ ~ ~ ~ ~ ~ ' • ~ wsconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' e oint BM direction and Parcel LD. inGude, but not limited to: vertical and horizontal referenc p ( ). percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2 r Please print all information. ~ iteviewed by Personal inrorrnation you provide may be used (or secondary purposes (Pnvacy Law, s 15.04 (1) (m)). Property Owner Property Location ~.~ ~'- Govt. Lot 1!4 1/4 S ,7 T Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~-° t T T ~L -' Citv ~ State Zip Code Phone Number ^City ^ Village Town ~.~tlL~n/y I Gc%~I ~'Yv/G I (~~~~ '"~(~PG I H`NO) DA! (f) New Construction User Residential /Number of bedrooms ~_ Code derived design flow rate ~~^''"" Replacement ^ Public or commercial -Describe: Parent material ~iK77,~~' ~L7~ Go,a A'1 Flood Plain elevation if applicable _ General comments ~ • G ,~ py and recommendations: ~,1, ~.~r~.~~ ,x,1• /~7- //~ y ~ /~ /' Page ~ of /U ~•.~70 ^briCJ Date 2~L OG ~9 N RI~ E(°~ N/ea es Road ~_ !~ GP •..~- ft / ~ Boriny Boring # i Z ft. Depth to limiting factor ~'in. pit Ground surface elev. ~ Soil Appliption Ra Texture Swcture Consistence Boundary Roots GPOIft= Horizon Depth in. Dominant Color Munsell Redox Descnpbon Du. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ~ ^ _~ ~ ~ Z - / _ L ~ / 3 ,zs- tii -- . 7 / 1 z ' s-- _-- s rrfL - -- ~s. ~i ~ ; ~ 3©~ o ~ L ~ Boring Boring # D ~S ~ th to limiting factor ~ in• e Pit p ft. Soil Application Ra Ground surface elev. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft' 'E(f#1 'Eff#2 in. Munsell t]u. Sz. Cont. Color • Gr. Sz. Sh. •~ I d to ~~. y ~ ' _ - L ~Nl~ .- ~ . _ SG -- - f c S '/ ~v r' 9J. 9 ~ ? Z yO.6.~ Z ~ .n. .,,....n -nnn ~ zn mn/t anA TSS < 30 rltOlL _., • Effluent #1 = 800, > 30 _< 220 mglL and TSS >30 < 150 mg/L r ----. .... .,__.. Sinnatur Address Fogerty Plumbing & Perk Testing 28288 McKenzie Rd. a Evaluation Conducted y 3 _ CST Number // ~l r Telephone Nurr 7~c-.tzs Property Owner ~t° Parcel ID # m?D ^ l/~~ -~ZB ^ Q~(/ Pape ~ of ~_ 3 Boring # ^ Boring Pil Ground surface elev. ! i Z 1t. Depth to Ilmiting factor ~~~ In. Soil Application R~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt In. Mansell Uu Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'E(f#s -- 0 ~ -,~ StL L .. .. 2- -~Z- . S - L ~ '- , y . S ~ -- q~r.,, Boring Boring # ^ Pit Ground surface elev. it. Depth to limiting factor fn. Soil Application R: Horizon Oeplh Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIit' in. Mansell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#: r D Boring # ^ Boring ^ Pit Ground surface elev. it. Depth to limiting factor ln. Soil Application RI Horizon Depth- Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Mansell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#; 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BODe < 30 mg/L and TSS < 30 mp/L ' The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or ~ need material ut an alternate format, please contact the department at G08-2GG-3151 or TTY G08-2G4-8777. saan~o ltt.wool t ~,~ \ ~. \ ~ .. ~ ~ ., ` ~ \ ~\ ~ ~~ ~- ~ .., ~. W yJ •~ _ --~, a w a M ~ r` 4 b n d `~~r • -~ L7 N fi ~ ~ h ~~ r n ~~ 1~ ~~ N bo~,~~~~,~~, ~~~'~~~a~~ar ~$. ~ r v 3 V LV ~ ~ ~ ~ ~ ~ A ~ ~ ~ '~ ~ ~ w ~ ~., ~~ ~ ~~ ~ ~ ~ ~ ~- n N O ~ h a ~~ ~ '~,' N ~- Wisc artment of Commerce SOIL AND SITE EVALUATION 'Div; o!y and Buildings Page ~ ---- of ,~ -. <Bure~u of Int~ir3ted Services In acc nice wll~h`s:.1LHR 83.09, Wis. Adm. Code L / S G i~ ~ ~ ~ i t ~ . - - . t ~ ';,. Gj, 7 2,Pi l~ C.G lw.v~.. f1 ~. Attach complete site plan on paper not less than 8 1 >~~'h~k'inches it~ze. Plan must. County ~~~ CMG h~~a include, but not limited to: vertical and horizontal r feTeNce poiI)4dfr~ction and \ ` St . CrOiX percent slope, scale or dimensions, north arrow, d_ TUcation a ti t1f51ahC~to neares>-rod. •. Parcel LD # ..r _ ...~ . , ~~ ~ "t . ,` APPLICANT INFORMATION -Please mall infQ r R viewed by Date . Personal information you provide may be used for second~ry..pu''rposes (Pri~gVys. 15.04 St~, S y C, D Property Owner i h d `" ' ;Prp y Location ~ d " ~ R c ar Stout ! --.-r ~ ; C 1/4,SG t. Lot ,~ 1/4,S ~G T ~Q ,N,R ~9 E (or Property Owner's Mailing Address ,_"-_~_,,,,,y..--~' Lot # Block# Subd. Name or CSM# 1353 Awatukee Trail 12 Brown's Ridge City State Zip Code Phone Number ty ^ Village ®' Town Nearest Road ^ Ci Hudson I WI 15401 6 I ( 71 5) 549-6731 Hudson I Meadow Lane New Construction Use: ®Residential /Number of bedrooms 3 Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow 4 5 0 gpd Recommended design loading rate . 7 bed, gpd/ft2 . 8 trench, gpd/ft2 Absorption area required _C_4 3 bed, ft2 5 ~~ trench, ft2 Maximum design loading rate ' 7 bed, gpd/ft2 ' 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) yy..3a ft (as referred to site plan benchmark) Additional design/site considerations Parent material Glacial D ep0 S i t Flood plain elevation, if applicable 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 Boring # 1 Ground elev. I~-~.~it. Depth to limiting factor 9 8 in. Boring # 2 Ground elev. J9.7Dft. Depth to limiting factor 1 1 0 in. SOIL DESCRI PTION REPORT Horizon Depth Dominant Color Mottles T t Structure n i n C t nd B Roots GPD/ft ure ex o s s e ce ou ary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trei 1 0-14 10yr3/2 Sil 2mabk mfr cs 1F .5'.6 2 14- 8 10yr4/4 Sil 2mabk mfr cs .5'.6 3 48- 8 10yr4/6 Ms osg ml .7..8 1 S (~~~ i n `~Ce, , ~~~ VV ~~ ' Remarks: 1 0-1 10yrs/~ Sil 2mabk mfr cs 1F .5 '.6 2 16- 4 10yr4/4 Sil 2mabk mfr cs .5 .6 3 54-1 10 10yr4/ Ms osg ml cs .7~.8 Remarks: SST Name (Please Print) Signature Telephone No. lntilliam S,bhi~ak]~~r ~~~~~~~~,~~~-~---_ 715-386-3121 Address Date CST Number 1 070 Scott Rd Hudson WI 5401 6 ~ ~^ ~~ PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3 Ground elev. 9Q,~fi. Depth to limiting factor 1~-S-in. Boring # `4 Ground elev. 9~ft. Depth to limiting factor 92in. Boring # 5 Ground lev. rY ft. Depth to limiting factor ~ in. Boring # Ground elev. ft. Page Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench 1 -36 1 0 r3 2 Sil 2mabk mfr cs 1 F . 5~. 6 2 6-6 1 0 r4 4 Sil 2mabk mfr .5 ;. 6 3 0-1 0 10 r4 6 Ms os ml .7~.8 Remarks: 1 0-2 10 r3/2 Sil 2mabk mfr cs 1F .5',.6 2 4-5 10 r4 4 Sil 2mabk mfr .5~ .6 3 2-9 10 r4 6 Ms os ml .7' .8 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fit in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 -24 10yr3/2 Sil 2mabk mfr cs 1F .5 .6 2 4-4 10yr4/4 Sil 2mabk mfr .5' .6 3 8-9 10yr4/6 Ms osg ml .7. .8 Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) SOIL DESCRIPTION REPORT PROPcR`P1fOWNER Richard Sto ~t ' ' PARCEL LD.# Boring # 3 Ground elev. 9Q.~ft. Depth to limiting factor 1~-in. Boring # 4 Ground elev. 92.~ft. Depth to limiting factor ~_in. Boring # 5 Ground lev. ~ft. Depth to limiting factor ~~.in. Boring # Ground elev. ft. Depth to limiting factor in Page _.~ ., . ~', Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 1 -36 1 0 r3 2 Sil 2mabk mfr cs 1 F . 5'. 6 2 6-6 1 0 r4 4 Sil 2mabk mfr .5 ; .6 3 0-1 0 10 r4 6 Ms os ml .7~.8 Remarks: 1 0-2 10 r3/2 Sil 2mabk mfr cs 1 F . 5; . 6 2 4-5 10 r4 4 Sil 2mabk mfr .5~ .6 3 2-9 10 r4 6 Ms os ml .7' .8 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPDfft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 -24 10yr3/2 Sil 2mabk mfr cs 1F .5 .6 2 4-4 10yr4/4 Sil 2mabk mfr .5' .6 3 8-9 10yr4/6 Ms osg ml .7. .8 Remarks: ' Remarks: SBD-8330 (R. 07/96) ~i~i~-~ ~• ,~.a drew '~. ~~.~~ 99,.SS ~Grilc 1' ~ ~ ^ ~ ~ ~ G ~. .~.~ocsti.l app tio~~Lr N N~`~ r er r G y LA r''a ~~ ~` p NPR • NS-~•.I U-~ I ~'J ~~ ~ u~~ln wwaw L~~.. lo,,~i ~fa,~-~. S~n,~ w~.u.ICrv t~~lyv .w . `Jllisconsin Department of Commerce SOIL AND SITE EVALUATION " 'Division~of Safety and Buildings Page ~ of Bureau of Integrated Services in accordance with s. ILHR 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 ~ ~" percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION -Please print all information. 'ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location S ~ Govt. Lot 5~ 1/4~Gc) 1/4,Sa~ T ,N,R ~ ~ E (or /V Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# ~- .~-~ r. 1 C3 ~ ~ R , d City State Zip Code Phone Number g ~ Town Nearest oad ^ City ^ Villa e U ~ J d c o n I f,, r ( I .S'~/!~ / (o I (7/S~ Si/9-!o 73 I ,~,,,,I c „ .•~ I ~ I u~ Tc~.. La r~ o ® New Construction Use: ®Residential /Number of bedrooms 3 _ / Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~~, v gpd Recommended design loading rate gybed, gpd/ft2~trench, gpd/fT2 Absorption area required ~_bed, ft2~d trench, ft2 Maximum design loading rate bed, gpd/ft2 - ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable 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 Q S ^ U ^ S ©U ^ S (~ U SOIL DESCRIPTION REPORT Bor//i__ng # lSJ Ground elev. ft. Depth to limiting factor ~in. Boring # 7; Ground elev. ft. Depth to limiting factor f /Zin. Horizon Depth Dominant Color Mottles T t Structure nsisten e C Bo nda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. c o u ry Bed ,Trench I a zo 1v _ Sr" ~ C ~ z o ~ siy - 5 ,~ ~~ - ,.~ , ~ 3 o-y~ r ~~ - oS CJs c • 7 -~ v r ~l~ - w, , ? Remarks: I I ~ r3 S ~` I (w~ b~ v~ r C..s l~ , ~ -y io r / - 5r mab/ yn.~,' CS .,5'x.6 Remarks: SST Name (Please Print) / Signat re / Telephone Noyes. 4ddress Date CST Number 'r.u%~1~. r~~,e, .LQ7~ ~2 X921 2- ",.oUC ~;~.¢. ,GI. iii ~, o7~t /~ . o z C 4~~G 1 '~` ~Q' ~ ~ tio~~ty G ~C. .~..~oc.stie! aPo~ -~~ N~` ar er r G y r„ ~)i2-I~~~`~ ~~ ~~i a ~~ i2°iS`~6 i ~/ •'~ X31 •~? ~~ yy~y(; ~anniani u~ l.un Unel Uti DiKi$ srety and Buildings SVIL ANU 51 I IC CVALUA I IVIV Page ~ of ,~ Erufeau of ntti~rated Services ' in acc nbei VS~I h'~s.. )LHR 83.09, Wis. Adm. Code ' '-- '. ' S ~ ~ a-f~ a,e l1 ~~ u..ti. ~~ Attach complete site plan on paper not less than 8 1 ~h inches ip~e. Plan mus~•~ County ('(~(cwYl Sc, 17~-na include, but not limited to: vertical and horizontal r fe ce poi~l~ ~1l~ction and ~„ St . CrOlX percent slope, scale or dimensions, north arrow, ~ dT~cation a ~ to nearesFT d. ...... ~ Parcel I.D. # , CUB ~~r n Q C D t1 6 ~~ ~ .-• $$ APPLICANT INFORMATION -Please ~_~ ri~ all inf~ R viewed by Date Personal information you provide may be used for second~ry;pulposes (PriGys. 15.04 S r fCD Property Owner .\.:' ~-Pxp Location " Richard StOUt "~,.~'";' ~~-~•-- .Lot .$ C 1/4~1.d 1/4,S ;?G T ~Q ,N,R l9 E (or~ Property Owner's Mailing Address '`-~., ~ ~ ~ Lot # Block# Subd. Name or CSM# 1353 Awatukee Trail 12 Brown's Ridge City State Zip Code Phone Number ^ City ^ Village ® Town Nearest Road Hudson I WI 15401 6 I ( 71 5) 549-6731 Hudson ~ Meadow Lane New Construction Use: ®Residential / Number of bedrooms ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow 4 5 0 gpd Recommended design loading rate . 7 bed, gpd/fit . 8 trench, gpd/ft2 Absorption area required 6 d'~ bed, ft2 ft2 , Maximum design loading rate ' 7 bed, gpd/ft2 ' 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ 7 ft (as referred to site plan benchmark) Arirlitinnal riacinn/city rnnciriPratinnc Parent material e O Flood plain elevation, if applicable 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. ~~~. Depth to limiting factor 9 8 in. Boring # 2 Ground elev. q~ft. Depth to limiting factor 1 10 in. Horizon Depth Dominant Color Mottles Structure C i t unda B Roots GPD/fit in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence ry o Bed ,Trench 1 0-1 10yr3/2 Sil 2mabk mfr cs 1F .5'.6 2 14- 8 10yr4/4 Sil 2mabk mfr cs .5'.6 3 48- 8 10yr4/6 Ms osg ml .7..8 V Remarks: 1 0-1 10yr3/2 Sil 2mabk mfr cs 1F .5 '.6 2 16- 4 10yr4/4 Sil 2mabk mfr cs .5 ;.6 3 54-1 10 10yr4/ Ms osg ml cs .7~.8 Remarks: CST Name (Please Print) Signature Telephone No. William Sbh>a~~~~r ~° 715-386-3121 Address Date CST Number 1070 Scott Rd Hudson WI 54016 q~/D"/Q~ 2~794d PtiOPERTY OWNER R i cha rc] St-_c~Lt SOIL Ut5GH11'T lON REPORT • s PARCEL I.D.# Boring # 3 Ground elev. 9~ft. Depth to limiting factor 1~-0-in. Boring # `4 Ground elev. 9~tt. Depth to limiting factor 9~in. Boring # Ground lev. ft. Depth to limiting factor 9~in. Boring # Ground elev. ft. Page ~~ ., w • a.', Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trench 1 -36 10 r3 2 Sil 2mabk mfr cs 1F .5'.6 2 6-6 1 0 r4 4 Sil 2mabk mfr .5 ; .6 3 0-1 0 10 r4 6 Ms os ml .7~.8 r;~'z~ ,, Remarks: 1 0-2 1 0 r3 2 Sil 2mabk mfr cs 1 F . 5; .6 2 4-5 10 r4 4 Sil 2mabk mfr .5~.6 3 2-9 10 r4 6 Ms os ml .7' .8 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 -24 10yr3/2 Sil 2mabk mfr cs 1F .5 .6 2 4-4 10yr4/4 Sil 2mabk mfr .5' .6 3 8-9 10yr4/6 Ms osg ml .7. .8 ~~ r Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) ~, ~~'~ _~ ~ ~ 2. ,';o.. a~ ~:; p.~ ~, fib ~ ~r~t ~cf~ • ~c 4~4 1 "` _ ~D' ' ~~ ti°~~~y G ~. ~.~oc.~tie~ oPo~ -~-~- -~ ~`~-D der N ,. ar -;nnsponsin QepartmePt of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau of Integrated Services in accordance with s. ILHR 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 ~ ~ ~ ~ ~ ' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # Page ~ of APPLICANT INFORMATION -Please print all information. ~ewed by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Property Owner Property Location Govt. Lot s~ 1/4Sc~ 1l4,Sa~ T ,N,R ~ ~ E (or~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# >4 ~.-~ r. 1 Q ~ Lu R . d City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest oad l l (7iS) -l0 73 ~ t fJ~2. a. Ga ®New Construction ^ Replacement Use: ®Residential /Number of bedrooms L Addition to existing building ^ Public or commercial -Describe: Code derived daily flow ~n~ gpd Recommended design loading rate ~ Lbed, gpd/ft2~trench, gpd/ft2 Absorption area required _~~bed, ft2~trench, ft 2 Maximum design loading rate bed, gpd/ft2 - ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system Q S ^ U ~ S ^ U [~ S^ U Q S ^ U ^ S ©U ^ S ~ U Boring # ou elev. Depth to limiting factor ~in. Boring # SAIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure i C B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence ons oun ary oo s Bed ,Trench I ~Zo 10 - S,"~ C ~ Z 0 ~/y U S , ~ tn~~ - ..~ • ~ 3 0-~~ ~ ~~ - oS Crs ~ - . ~ -~ ~ r l~ - ~ •?~ Remarks: I I n r3 - S ~~ I ~ fM~ ~ c1 ~S (~ ~ ' elev. Depth to limiting factor tlZin. Remarks: - CST Name (Please Print) Signat re Telephone No. Address / Date CST Number Troup ~.f~-~ 'e. ~.~'7~ /.~ '~~ ~ c 1 'T- ~D' ' ,~ p~~ yY ~~i a ~~ ~ ~' 4 ~~ G ~. ~.~oc.~tir~ mot ~' ~.-®~r- ``°~ .~? ~~ u~cJln ww~w' (,tr.o.. ~ S~ ~a-i l ~,~pd,/~- (ACfv(~v~o(v~ -F-~= ~ y,o~~1 er N ,, or y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner~aper ~'i~ Lo,tJt)"• Mailing Address ~6~6 ~ ~ S~`T. /~Gc DSo~t/~~p~e I! Property Address (Verification required from Planning Depas~ment for new construction City/State 1~1t ~FDI~, c~ Sy©/~ Parcel Identification Number D2o -- /3 ~/.~ -/.~- - ©~D LEGAL DESCRIPTION Property Locationf~_ '/,, ,~ '/,, Sec. ~ ~ . T~N-R~~~i~, Town of ~L/D>U~y Subdivision ~/?©Gr/.~1' ~LL]~~C ,Lot # ~. Certified Survey Map # "~- ,Volume ,Page # ~ Warranty Deed # ~B9 ~/ p Volume / yS'Z ,Page # 3 3 ~. Spec house ^ yes no Lot lines identifiable, yes ^ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set f herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification slat' g that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da~s of the thre ea xpiration date. / SIGNA F APPLICANT DATE I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the operty d~SCribe~J above, by virtue/of a warranty deed recorded in Register of Deeds Office. ~ I ~~''// SIGNATUI~,/OF APPLICANT / / DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ,~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number I; W ~0~ 14 52 PAGE 3,3 This Deed, made between ~T(_HARD~ STRUT anc1 JANET P STOUT, hu~hand and wife Grantor, and UC ` Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St . ~'.S'O].X County, State of Wisconsin: Lot 12, Plat of Brown's Ridge, Town of Hudson, St. Croix County, Wisconsin. (SEAL) n2o-1110-20-ono Parcel Identification Number PIN11 ,~20-1110-30-~00 his homestead property. is (is not Exceptions to warranties: easements, restrictions, rights-of-way and covenants of recorod. Dated this 25th day of Al~L1Rt 1 999 . Richard O. St(o~ut~''j~ (SEAL) AUTHENTICATION Signature (s) authenticated this day of (SEAL) TITLE: MEMBER STATE BAR OF WISCONSIN Es0941$ KATHLEEN H. WALSH REGISTER OF DEED5 ST. CROIX CO., WI RECEIVED Fit RECORD 08-P7-1999 9:30 AM WARRANTY DEED EXEMPT If CERT CDPY FEE: ° COPY FEE: TRANSFER FEE: 10.70 RECDRDING FEE: 10.00 PAGES: i Recording Area Return dress ---___ -- ~ ~`'`•~-` `-'~ `-~' ~ 5 y o `'rD ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. CRoix County. 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