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HomeMy WebLinkAbout020-1349-13-000. ' `' ~~'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may oe used ror secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Villa e ^ own off:. lelta Construction, Hudson ownship CST BM Elev.; Insp. BM Elev.: BM Description: l ~~, s TANK IN FORMATION - TYPE MANUFACTURER CAPACITY Septic ~Z Sb Aerati Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~ ~~ 1 ~ C 3 ~ NA sing NA Ion NA Holding PUMP /SIPHON INFORMATION nufacturer errand Model Num G Lift Lriction S stem TDH Ft Forcemain Length Dia. Dist. ELEVATION DATA Coun~~ Cr01 Sanitd/y 2~rjr}jt No.: StateJ3PlJa.SSn IDOOU ~No.: ParcebT~ac °349-13-000 STATION BS HI FS ELEV. Benchmark Z Alt. BM Bldg. Sewer ~ ` Q / Ht Inlet ~~ Z ~/ Ht Outlet .,s3 y'y Y Header /Man. ,zz q, z y 9 j.~ z Dist. Pipe cMl-rz f;~G ~3 8' Bot. System 4 ~*= /: °o i b 4~ •q L Final Grade ~?' ~f'~,/S St cover ~ 9 p SUILA650RPtI0N SYSTEM Z ~ !rL / ~/_ /__~ Ik BED / REN Width ~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N •.~ 3 DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM L G M facrurer: INFORMATION Type O ' ~ f - / MBE Model Num er: System: ~ ~ 3~ / °"_ O ~ o DISTRIBUTION SYSTEM ~ Header /Manifold ~/ Distribution Pipe(s) ~ x Hole Size x Hole Spacing Vent To Air Intake U Length ~~ Dia. ~7 "~ Length G2. s Dia. ~& Spacing ~ " N ) r 3 ~l- 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: ~ / L(j/ a a inspection ~tL: t / Location: 751 Blue Jay Lane, Hudson, WI 54016 (SE 1/4 SW 1/4 26 T29N R19W) - 26.29.19.1889 Browns Ridge -Lot 13 1.) Alt BM Description = ,~ ~ / ~ / .~ 2.) Bldg sewer length = A ~`~`~ ~ `~3~`t'` ~ v~~~ s~~ ~°~~`'~ /~~/'t S -amount of cover = ~ '~*f~ o ~ ~A~~~v F ~` 3.) ~'~(~(r' ~~4( ~~Q~/QUO y~) ~ r,.,P ~~ ~- ~-h~ Plan revision required? ^ Yes (~ No Use other side for additional inform {ion. ~-- Z ~ ~ SBD-6710 (R.3/97) Da a nspedor's Signat e Cert. No ~. ,,, . i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~~ f < ..~ , ' ..- >< pp ication Safety & uilding iviston In accord with Comm 83.21, Wis. Adm. Code 201 W. Washin n 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 ISepartrtent of Cammeree [privacy Law, s. 15.04(~~ (Submit completed form to county if not state owned. Attach com lete lans to the coon co onl tine t n t less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number lion State Plan I. D. Number ~ 3S3 3!v I. A lication Information -Please Print all Informatio •, Location: Property Owner Name ~ Property Location 10 __ , t1t ~ 1/4 /4, T ,N, Property Owner's Mailing Add s ~ `1. ~. i G~ ~~ Lot Num er Block um r H ,\ r~ SGOV ~FF~G~ ~ City, State Zip Code \ hone ~: ~ Subdivision Name or C9IaHdmnber- ~~ ' o - ~~~~ ~ ~~ s II. Type of Build ng: (check one) -- --• ~ ~'ty ^ Village 1 or 2 Family Dwelling - No. of Bedrooms :~ /Commercial (describe use): bli ^ P j~Town of _ c u ~,A / / ~~~5 " ^ State-Owned " v ~1~~~~yv~~_~ Neazest Road e , r III. T e of Permit: Check onl one box on line A. Check box on line B if a licable p) 1. ^ New 2. ^ Replacement 3. ^ Replacement of 4. S. 6. ^ Addition to S stem S stem Tank Onl Existin S stem . Permit Number Date Iss ed 269 A , ~ 3 N. T pe 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- de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: Dis ersal/Treatment Area Information: .Z V . 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal ~ Z~ 4. Soy Appli lion R S. Percolation Rate h) /i Mi 6. System Elevation 7. Final Grade Elevation Required ~ Proposed $ . .) Rate (GalsJday/sq. nc n. ( a - .~~ ~, VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- P astic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ 1 d -- .?Oo .~ S ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS own on the attached Tans. Plumber's Name (print) Plumber's Signature (nos ~/MPRS No. Business Phone Number .-~ ~-~ / /~G - S ip ode) lum ~s Ad ress (Street, City, State, Z / ' d O G ~J^ LL ..f ~ IX. ounty/Dep tment Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ~ ~$(Approved ^ Owner Given Initial Adverse Surchargq.Fee) ~ ,.~ f ~D D ± ~.~J~, Determination X. Conditions of Approval /Reasons for Disapproval: 1( ~C A-l-4~a~ y~{-~L S~~{uw~ eri.i.~ w~. ~t`~=L ,p~ttwt~ee~.a ..~~+~." an9.o~ ~ayl' G.9-{.~,lD~n. V ~Q..~C ' 4-I o -1948. V ~ s l eu-~~-~~~) . l ~''°'" Q ~ ~ -E c ~ -~ .. .p r -~ ~- e.. __ a.- r ~ mo"t"`"' ~~ ~:1~-/ ,N..o~. #~- -be.. v~~ ~`~K9~ 2R . I~- ..~ o) r • -r ~cT ~~&~ _ pc~ ~,e~ /C o F < .~/o ~~s, a-a ' l 1 /'~~' /4t}VE I; ,~ I , ,. ~~ ~~ ~. LET '~/3 ,sca~C,E / „-Yo Gr#~ _ ~ir~ 7v~ 6f ~~.~6'E S~XvlL.E' Orz7~ S.IXL~ /QUO ~ d ~~ = ~oatp~ ~ ~ ~if~'~ ScArn~Gi 9( O~r X = /~ytTNlr c ~aw~ 6~T Co~w~7= _ ~ Mme ~L, s.7: mF rysr €,rr. ~i m la `~ ' ~`~~ ~ ~ }. ~ r ~~ SS - ~ ~~~ ~~ ~~ ~ a /-i~66 7~..~vo ELFd. _ ALL ~i~,ef/Et ,¢T 9/• P 3-3X6.2•S AIC'Cal.~M'~E'A ~ . B~ L ~1/ ~~/isconsin Department of Commerce SANITARY PERMIT APPLICATION safety and Buil9ings Division 201 W. Washin ton Avenue In accord with ILHR 83.05, Wis. Adm., ~de~ I ~ ~,~_ P O Box 7302 ~ ~ ,,_ ,,r Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, o Ra er notes ciaun3y. , than 81/2 x 11 inches in size. `~/' 1~~~~'~~~~ ~ ~ `, ~ n • See reverse side for instructions for completing this applicatio ~ k Sanitary Permit Number Sta Per l inf ti id b f ~ ~ ~ `~, ~a sona orma on you prov e may e used or secondary purposes ~ >~I p I-I Check if revision to revlous pplication (Privacy Law, s. 15.04 (1) (m)]. ~ ST C t ; -+, ~ Stake P U. Number ~ I. APPLI ATI N INF RMATI N -PLEASE PRINT ALL INF T f Property Owner Name ~ ~ r erty Location: ~ f 1 fll T , N, R ~ E (o~ Propert Owner's Mailin A dress Lot Num Block Number ~ ~ ST• 3 City tate Zip Code Phone Number Subdivision Name or CSM Number II. YPE F ILDING: (check one) ^ State Owned ^ !t Nearest Road ) Public 1 or 2 Famil Dwellin - No_ of bedrooms ^ Vllfage Town OF D~/ l~Ilr~i ,~~ . III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number . n Q - 1 ~. ' G~ 1 ^ Apartment /Condo ~' / 3 't '- ~ j' ~~ 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 box on line A. Check box online B, if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5_ ^ Repair of an ______System ________System _ Tank Only______________ Existing System ________ Existinc~System B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed ~v ,~ ~~J 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12~Seepage TrencFl ~ 22 ^ In-Ground Pressure . ~i 42 ^ Pit Privy 13 Seepage Pit ~ ~ 3... 3X ~ 1~ 7 J 43 Vault Privy ^ ~ 'z ~~.tf~x`~2J 14 ^ System-In-Fil ~ ~ ~ ,S~ ^,,, ~fLS ~ VI. ABSORPTION SYSTEM INFORMATION: '~-"'-' '/r 1. Gallons Per Day 2: Absorp. Area 3. Absi~r~a 4. Loading Rate 5. Perc. Rate 6. em Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/daylsq. ft.) (Min./inch) Elevation O 03 , $' ~ 3 Feet D .O Feet VII TANK Ca aclt . INFORMATION in gallons Total # of Manufacturer s Name Pretab. site Con- l Fiber- Plastic Exper. ' N ti E i Gallons Tanks Concrete Stee glass App ew n x s strutted Tanks Tanks Septic Tank or+leldir+g~k Gtj~~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of onsite sewage system shown on the attached plans. P tuber's Name: (Print) Plumber's Signat No St s) MP/MPRSW No.: Business Phone Number: cG/ a .~, 2211~'D ? -- S P u er's Address (Street, City State, Z p de): ~~. w~ 1'yo -3 IX. COUNTY/ EPARTMENT SE ONLY ^ Disapproved Sanitary Permit Fee (I"cludesGroundwater at ssue Issuin A t Si t re (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) ~L~ cso/ , .~ Adverse Determination X. O DITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: 5GY1 ~yyiN SBD- 6398 (R.11/97) v DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 mairitained. 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 and Buildings Division, 608-266 3151. To be complete and accurate this sanitary permit application must include: I. Property owner'sname and rrtailing 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 on 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 for numbers 1 through 7 VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to 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 8.1/2 x 11 inches mu-st be submitted to.the county. The plans must iridude 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; dose volume; elevation differences; frictionloss; pump performance curve; pump model and pump manufactures;. 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 WiscorisinAct 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 contamination investigations and establishment ofstandards. i Of rj~p~rr}a v fy 3o d xr~--~'- a ' o • ~~ g-~ B•~ p z ~ ter, ~~ SID t 1~ ,, FOnf'ly PIN111b~11s ir:221180 28288 McKenzie Rd. Spooner WI 54801 (715) 635-9609 ~~~~ Ltt~tL K~v6R ~ S/ YD~ ti ~ L~ ~ ~ ,o' ~ : s -' 1 s ~ f- - \ / ~/ i ~ i ~ ~ ~' LsT ~` /3 , 2 ~rc~t~s ~~ d#~ ~B p~ m~ ~ ~ / ~ = a~~s p ~ ~ ^ ~1 ~v ~,~~ s.T ~ 1 , ~ j-fJri~l~ Go? Co/2.v1~'R-S ~ ( .. .-~ - ~cZ n~ Co.~7` I 3/2p/~ , _~ 4 ~ - . ~~ Wisconsin Department of Industry, Labor and Human Relations Division of Safetv & Buildings SOIL AND SITE EVALUATION REPORT Page ~ of 3 ~~~ uvvv~v ~.~u~ ~~~ ~~ a va'.vv, •~~v. ..u~ vvuv • COUNTY Attach complete site plan on,paper not less than 8 1/2 x 11 inches in size Plan must include but ~ C , . not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # oZ~O. a9. /q• / dimensioned, north arrow, and location and distance to nearest road. ~J51 6/~lE' f _- 3 - - G~C~ ~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~ REVIEWED Y DATE ~ /~ -?.640 PROPERTY OWNER: PROPERTY LOCATION E''G S GOVT. LOT s~• 1/4~ 1/4,S,j~, T 2 ,N,R / E (a~ PROPERTY OWNER':$ MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ~y T• 3 -- o ~ .fie ~~ CITY STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE OWN NEAREST ROAD New Construction Use [/~ Residential / Number of bedrooms ~/ [)Addition building j [Replacement /[ ] Public or commeraal describe CC Code derived daily flow ~r _ gpd Recommended design loading rate ~~bed, gpd/ft2 , 8 trench, gpd/ft2 Absorption area required ~~~ bed, ft21 't' trench, ft2 Maximum design loading rate bed, gpd/ft2 --- trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ - ffr /f ft (as referred to site plan benchmark) Additional desi n ! si~~JJ' con eratio s L Parent materia9 ~~,~~g~~ FI plain elevation, if applicable -~- ft S =Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitablefors stem ^S ^U ^S ^U OS ^U ^S ^U ^S ^U ^S ^U SOIL DESCRIPTION REPORT Boring # ^ty }jti:? "" :i~ti S:iiii:: Ground e~_lggv. fl.~ft. Depth to limiting factor Boring # ~~+: :3:; Z .''``• 9~0~::.. Ground ev. . 9 ft. Depth to limiting fact0~ i H Depth Dominant Color Mottles Texture Structure Consistence Baxxia Roots GPD/ft or zon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ry Bed Trerxfi 2 /- 7 - 3 ~- .~~ ~ s Z 3 = G - .-8 /e -~" -~ sG G - - __-- 4/. Se rS.Lo/91~Z° Remarks: _ / ` O ~„~ ~~ Z - 3 __-- srG. r ~~ - Y --- s ® - . /6 0 - .~' s ©sG -- ____ f.2 4~. Z Remarks: Phone: .......,.._. ~ !~ 3 GtJ.~ S Dom. Signature: ~ ~ ,, Date: CST Number: PROPERTY OWNER L/•-G7'/~ PARCEL I.D.#/9sY9-'/3~~ /3 -~7 Boring # .;,...,. :;?:j ~~~~~: ~rowid elev. , ~~ ft. Depth to limiting %o/ a SOIL DESCRIPTION REPORT Page Zof ~rY Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. ry Bed Trench ~'~ Q r ~~s Jv.-~ ~y //! r z. a3 7s- sL ~ 8 z .S ~S~ /1tL - - ~ . ~ i Remarks: Boring # <: Ground elev. ft. Depth to limiting factor Remarks: Boring # kti::iy'.~.i:::::::: 'F.•f;} ~ ~ iriiiti ii' Ground elev. ft. Depth to limiting factor Remarks: Boring # : p ~'ii•:i=i:=n ; {ki :;: :E ~• =i '.,v,+; ti Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8. 05/92) .. 1 1 t----.ZSi'-' i ~ ~ ~ I ,~° i I _, ~ ~ d~tx - - -- - x ~ I~ I k ,~~r. ~/, x ,~~~'64 ~ - - kE ~,t.Ft/.rmu s ~~tIC ~, 1 ~~/?: Fogerty Piuteb~ ,, #221180 28288 McKenzie Rd. Spooner WI 54801 (715) 635-~G09~ , ~ ~~~ ~~~~ ~~~° ~~i-..`G L~/L StLL /00.0, ~ d ~€ = ~, Berro~ of .src~G, P~ ,Y, " X = ~t~r.VG ~, = fmuiv) LoT Coe~/~ ~NO wEtt~ ~~ _. ~ I I __ ~ ~ _ i _. t i t I i f ~ I . ,_ , i ..1.. .__ _ _. 1 t _ _,._ ~ _ .... --~_ _. . _ I I ._-~ ~ _. ~fll~iR S11~ ~f9 t3~ ~ Q C A .i ~. i ~. _.. ~ ___._.1 _ .. __ _ ~ I~ .„, _.3 --- ~-- - . ---_ _ r ~ __~_ ~ .._ ~ - -- - .. . ._ _; _ ;. _ _. fi :_ . __ . _ ~~ ... . _ _._ . r , _ , _. _ . _ _ . _ .. . _. . ~_ 1 _ . ._ --< - . ____ _ - . t ~ i ~ 1 ~ ; s ' ~ t- ~ -- ~ 1 , ,. I i k rr i ' i i. > ~ , t ~ ' ~ ~ ~ I 1 i ~ ~ I ( I .. -, -- ~ . I ~ ~ ~ ~ ~, ~ , . ~ _ ~ , ' ~ t ~ - • , ,. ~ ~ k i ,-- ,~: -- _; ~. r _. _.- ._. . _. }_ i _ 1, i ~ I .. j ~ :_ ~.~ {. i ~ I ._ - i _ ~ I _ --- - ~ ! ~, ~ _ ~ ~ ~ ~: ~~ ~. r ~~ ,., ~. ~. I - - i i ___ t r ~ f _ ~ i .. ~ .. ~ ,.~ ~; .. i, i ~ ! 1 ~ ~ ~ j ~ l .. ~ ~ ~. , ~ ' ... .. ~ i ;. ~ ~ i j p _ ._ __ ..__ . _ . .. _._ . _ : _ . ..__~. _.__ - .._...e__..-_..... ~ i y _ i_ _ ._ _... _ .. . j _ -_ _ Wisconsin Department of Commerce . Division of Safety and Buildings bureau of Integrated Services • w Attach complete site plan on paper not less than include, but not limited to: vertical and horizont percent slope, scale or dimensions, north arrov~ SOIL A_ND SITE EVALUATION in gra(ahce~uvlt(i~., ILHR 83.09, Wis. Adm. Code s Tao i3 '~.~Q~ \ ~~ ..,._ // ~,.~ l(l,x'11 i es"Ntsiz Plan must fence p~~t"b~~~ectiori'and~~ c~'location anc(distance to nearest - .. St. Croix Parcel I.D. # Page ~ of APPLICANT INFORMATION - Pleas$ print all i->,fpgp~n. ~~=``' ~ Reviewed by Date < ~ Personal information you provide may be used for secortdary~~rpos ~~w s. 15.5?d,(1) )). ~, ~ , ~ Ol Property Owner `r f"' ~.s °y ' '~ t ` `Pr erty Location ~ " Richard Stout ~; i`"~ 4 ~ • ~ a , ovt. Lot s ~ 1/4s ~ 1/4,S ~G T~~j' ,N,R ~~ E (or) V~ Property Owner's Mailing Address `"-~--~- •••~ Lot # Block# Subd. Name or CSM# 1353 Awatukee Trail 13 Brown's Ridge City State Zip Code Phone Number g [~ Town Nearest Road ~illa e ^ C~H ^ Hudson I W1 15401 6 I (71 5 )549-6731 i Meadow Lane uds o ® New Construction Use: ®Residential / Number of bedrooms 3 Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow 4 5 pd Recommended design loading rate ~~bed, gpd/ft? ,._~trench, gpd/ft2 Absorption area required-~~bed, ft2~stonch, ft2 Maximum design loading rate ' S bed, 9Pd/fiz ' 6 trench, gpd/ft2 Recommended infiltration surface~evation(s) 9~. ~' 3 ft (as referred to site plan benchmark) Additional desian/site considerations Parent material Glacial DepO S l 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 SOIL DESCRIPTION REPORT Boring # Ground elev. ` ~~ft. Depth to limiting factor 1 1 Qin. Boring # 2 Ground elev. /r~ft. Depth to limiting factor ~_in. Horizon Depth Dominant Color Mottles T t re Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex u Gr. Sz. Sh. ry Bed ,Trench 1 -24 1 0 r3/2 Sil 2mabk mfr cs 1 F . 5' . 6 2 4-6 10yr4/4 Sil 2mabk mfr cs .5; .6 3 0-1 0 10yr4/6 Ms os ml cs .7 .8 y ~° g~',aY Izs.~ ~~ Remarks: 1 -24 10 r3/2 Sil 2mabk mfr cs 1F .5; .6 2 4-6 10yr4/4 Sil 2mabk mfr cs .5~ .6 3 5-9 10 r4/6 Ms Ms ml cs .7'.8 ~l off` , Remarks: SST Name (Please Print) Signature Telephone No. William S~~>¢tt~~fi~>sr ~'~,~,`_~~~ ~ (71 5) 386-31 21 Address Date CST Number 1070 Scott Rd Hudson WI 54016 ~,r ~y(~g~a PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT ~, 3 . Page ~ et PARCEL I.D.# ~ ~ ' Boring # 3 Ground elev. Depth to limiting factor min. Boring # '4 Ground elev. /a"~~ft. Depth to limiting factor 1 Quin. Boring # ;5 Ground elev. Q~l~ft. Depth to limiting factor 9 8 in. Boring # Ground elev. ft. Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 -18 10 r3 2 Sil 2mbk mfr cs 1F .5'.6 2 18-5 10 r4 6 Sil 2mbk mfr cs .5..6 3 0-9 10 r5 6 Ms os ml .7~.8 ~;~ G~ oY o o Y ~~ Remarks: 2 24- 8 10 r4 6 Sil 2mbk mfr cs .5~ .6 3 68- 00 10 r5 Ms os ml .7'.8' 0~•6 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 0-1 10yr3/2 Sil 2mbk mfr cs 1F .5 .6 2 18- 8 10yr4/6 Sil 2mbk mfr cs .5' .6 3 68- 8 10yr5/6 Ms osg ml .7~ .8 Remarks: Depth to 1~ limiting factor in. Remarks: SBD-8330 (R. 07/96) _.)Sh~ (;~ "~~rc ~ ape d.1.~7'/i ~~~f~ /DD. a -,~i~~z - ~ X ~~ ~;nt ~v .~~~ ~ tc 49 as ~ ~~ ~~acx P"'y ~'~ ~~ ~t ~ • Rr; ~ ~%5 X63 ~1~7 ~ `Ba gs -e%s ,. S c e~~c / = 5~0 ~C ~(iTCSY~sr ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/$~}tzr D,~GTi~I~ Mailing Address ~BG .Z ~~`' c7• /1~ l,L~pf~/ ev-~ C yD/G Property Address 7S~/ ~L (Verification required from Planning Department for new constructi City/State ~Gt/JSoR~, cry .~/~ Parcel Identification Number DSO - /1 ~/~ /.~- ~J LEGAL DESCRIPTION Property Location ~_ '/., ~~ '/., Sec.~,~~ TAN-R~_W, Town of 1-~1~--. Subdivision _~/Z~ir/S' ,er7~GE ,Lot # ./3 Certified Survey Map # Volume ~- ,Page # Warranty Deed # ~i0~ ~//9' Volume / ~/S~'Z ,Page # .~3~ Spec house ^ yes ~ no Lot lines identifiable~J 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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 forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the e y ar expiration ate. SIGNA F 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) the owner(s) of the roperty trscri d above, by irtue of a warranty deed recorded in Register of Deeds Office. ~~'` S /L~/ r~° SIGNA 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 decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed z ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/~~r _I~,€GTi4- Mailing Address .~BG 2 ~ c7• ~ l_~,pf~r/ ev.~ rSID/G Property Address 7s'/ /3~u~ (Verification required from Department for new City/State __t/Gt/>So~, c„c~ .~'yO~G parcel Identification Ntunber DSO - /3 ~/ j /~- ~'J LEGAL DESCRIPTION Property Location ~ '/,, ~~ y,, Sec.?...~~ TAN-R~~W, Town of ~,(~ii/ Subdivision ~lZDce~ids' ,C27~E' ,Lot # J3 Certified Survey Map # - ,Volume '-'- .Page # Warranty Deed # ~Df' Sj/? Volume / ~/.S~Z ,Page # .338 Spec house ^ yes )Z1 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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 forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix County Zoning Office within 30 days ,bf the e y r expiration ate. r - ,.law ~ / ~/ fI"b SIGNA ~ APPLICANT DATE OWNER CERTIFICATION I (we certify that ail statements on this Corm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty serf d above, by irtue of a warranty deed recorded in Register of Deeds Office. 5 /LDl 1>-'D SIGNA 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 Crom the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed l ~ ~ STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number v0I. 1~5~PAGI 338 This Deed, made between RTf'HARn C)_ ST(~iFT and JANET P. STOUT, husband and wife.,-_ -__ _-.__.. .._ -_-' -_.__T_ Grantor, and B;n.ItT71 GAPdSTR(1GTI8FJ~ ~N6. ----- .----.... _ __ __. _- - .-_. 020-1110-20-000 P I nti r u r This is nOthomestead property. (is) (is not) State of Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In $t,-~.pn~~]L County, Stale of Wtstonsln: ' 4{i.,!:f)!;tlr'i(.j Alin Lot 1 3, Plat of Brown's Ridgy, Town of 'N and tt . wwn,m a Hudson, St. CRoix County, Wisconsin. ~.~~~(k- ~~~"``~ dd ~ a wo ~r Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 2 5th day of A„q„ s t 1.9 9 9 R9 eha d n_ (AT1O- t ,~ (SEAL) ' ~ ~ _)J0~ (SEAL) Signature(s) _ authenticated this day of ,Tanet P_ STout/~~,,.,~ (SEAL} (SEAL) ACKNOWLEDGMENT State of Wisconsin, ss. St. CROlX County. Personally came before me this 25th day of 1F1y49tyst--:->o,g ~, the above named _ R; chard t7 _ STout andTanet P _ ~nn1• • _ TITLE: MEMBER STATE BAR OF WISCONSIN NaT/1FIY R; t@"S to (IF not, me known to be ~TI~~ ~~~he Foregoing authorized by §706.06, Wls. Slats.) insttrtment~acknoa~eJ BAS+-'- ~" THIS INSTRUMENT WAS DRAFTED BY Janet P. STout 1353 Awatukee Tr. Hudson, Wiu 54016 Notary My c I (Signatures may be authenticated or acknowledged. Both are not necessary) ' Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1998 AUTHENTICATION 609419 KATHLEEN H. WALSH REGIST£k OF DEED5 ST. CROIX CO., WI RECEIVED FOR RECORD 06-Z7-1999 9:30 AN MAARANTY DEED EXEMPT t CERT COPY FEE: COPT FEES TRANSFER FEE: 10.70 ~ORD=IN6 FEE: 10.00 ([f not, state Wiswnsin Legal Blank Co.. Inc. mewaukes• Wis. its ,- ~~ ~ w .. z ~~ = ro ° Cb 3 ~D n r ,i O ~ --I ,~ ~O/ ti ~ O .o ~ r ~ O w ~ 4~ ~ ~ N_ ~ ~ V ~ V v V V 0~ ~ ~ N ° o, . ~D I ~ ~ i ~ I I I ~ ~ I N I N02'S3'1T"4/ 323:57' ~_~, 60 251 ~ I _ ~ y 9Z~ 71 - . -. . ~ . •--~-284.77' w " - ~ ACCESS EASEMENT• - ° o N ° o ~; N m `0 _- 323.57' I ro ro . °~ o c°D ° I n t0 N V ` o I CA £ :'' £ I z .o w N o °` o ~ ~ r I ITl !7 ~ o p N N I d ~ '~~ o ~ ~ r ~ rv ~ ~ .~ ~ ~ ITI Q Vl D ~ ~ ~ d M ~ S7 C7 ~0 ~ ° ~ -~ _._. ~ D a ~ ~ ~ c n I fTl • I d ~ a ..~ • I ~ • ~ r~ 254.86' 284.37' ~ I C I ~ N00'09'40"E 539.23' ~ O \ -~ 3 ZD-1 r D ~ ~1 ~ ~~ D F+ O \ r UI / msg. ~ / S3 \\\~jc~ ~ ~ti ~ So•S~l .,18'8 . .~ ~ 80.E I ~ ~ l \~~~ 1y' ¢8g' ~9~' ~s .r . r ~ ~ ~ 1 H I I n v N o I V V ~ ~.~.. ~~ N V ! c7 ~ . _ I "rI N00'09'40"E 541.80' . t I . I r W v N ~.~.~ I I (J1 N V j- . ~ p? I ~ I N00.09'40"E 491.68' ~ ' I _ I _._._ ~ . ? N I vo ao v. ~ °~ ~ ~, - •~ ~ .~ I w ~~ w ~< ~t ~~ ^X N ~ V bb ~~3~ ~~~r ~~~~ r q ~~~ r ~~d N N n O d N ~ NZZ Z -~ frl ~ C O ~ N D ~ ' (n D ~ C ~ ~ ~ ~ ~--~ ~ C--1~ ~~v~ C7DD Cmf --+ ~..m ~ .rzK ~N~ H D 2 N ~ =r <~~ `" v ~z= ~ ~ m~~ r ~~Z _°~• ~ = s o~~ Nm~ m r A '~ t r~i~~ -~ --~ r~i~r n~~ ~~~ n~ n ' ' 4~sconsin Department of Industry, $ O I L AND SITE E V A L U AT 1 O N REPORT Page ~ of ~_ Labor and Human Relations Division of Safety & Buildings ,,.,~ ...:.~, n ,_ro ~~ .,~ ~A,:., ~~,.., n_.,,. ... _.._.,.........._.......,..,.., ..,,..........,.,..., COUNTY Attach complete site plan on paper not less than 8 1!2 x 11 inches in size Plan must include but C . , 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. /S APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~ \~~ `'1 EVIEWEDBY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT ~ 1!4 tl4,S~, T ,N,R E (q~ PROPERTY OWNE~RC:S MAILING ADDRESS LOT2 BLOCK# SUBD. NAME OR CSM# ~ ~ ~~ 3Q l1! G9 CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE [afOWN NEAREST ROAD o ( ) 8(r'-7 [/J New Construction Use [ /J Residential / Number of bedrooms 3 (]Addition to existing building j) Replacement [ ~ Public or commercial describe Code derived daily flow ~s~ gpd Recommended design loading rate gybed, gpolft2 .8 trench, gpolft2 Absorption area required ~ y3 bed, ft2 S6J" trench, ft2 Maximum design loading rate . Z_bed, gpolft2~~ttench, gpolft2 Recommended infiltration surface elevation(s) %~ 3.S - 9y 7 ~ 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 s stem ~l S^ U ^ S ^ U ~d S^ U ^ S ~ U ^ S ^ U ^ S ja U SOIL DESCRIPTION REPORT Boring # ;;::.: ,.; . €' r Ground elev. ~~ ft. Depth to limiting factor Boring # .... ,... ::.:: 3;: ~~} .:_:~ Ground elev. ~~~ ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Baixiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerlctt / - o -- - L S o G- L S "~ & I ~ ~ Remarks: l0 - 3 -' S G S . ~' Q i 1U Z -8 S SG L ;' S ~ ~''ONI NTY GOf~f E Remarks: Name:-Please Print S' ~-~E~-T't~ Phone: 1 ~/~--~ ~LS6 ~ -. nature: n_ /~- ~ Date: CST Number: . PROPERTY OWNER SOIL DESCRIPTION REPORT PARCEL I.D. # Boring # ~~• ..,. <~ >< Ground elev. ~~6- ft. Depth to limiting factor Boring # } ~~ ..y:: Ground elev. ~~ ft. Depth to limiting factor Boring # ~~~>`~ ; Ground elev. ~~ ft. Depth to limiting factor Boring # }:;Y is t.: ..n }:;:,v, t;;•'. Ground elev. ft. Depth to limiting Page 2, of _,~ i H Depth Dominant Color Mottles Texture Structure Consistence Borrriary Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench a- 3 ~ LS s 2 S ~ ,b' z -- s v s~- L -- -- Remarks: / 0- 3 -- L s rh nr S '. 7 L -3 - ~" G L c F ~S ~ ~,S Remarks: Z .?. S -- ~ S O S~ `h L- C 5 -- Remarks: ~, ~~ ~3Z33 •3289 ~ H is Phone 7 9-3656 ., a L 0 ~ ~ ~ r- x r ~~ I ~ # x ~ w I ~ v ~<- w -~x ~- ~ ~ _ ~, v~ v I~ ~~ ~ 4 ~ ~ ~ ~ ~ ~ ~ o ~ ~ ~'1 ~ r ~ ~ ~ , ~~ ~~ ~~~ ~,;N r`r, e v ~ ~ \l T~ ~ ~. ~ ~ ~ ~ ~ 0 ~ ~ ~ ~ 1~ Z ~1 G ~ ~ b °a I~ ~~ o ~~ <- 'w ~ 0 -T ~ A i~ i ~e~ Rw ~ ~~ ~ '~ W D W r---- ,, • • • s !C !Cn r z ~~ ~ ~ i~ / z ~' ~~. rn w~orH ~ ° ~co w o~ ~, _ . ~~ .. .: ~ ~ IY C~~. i A o ~~ o~ma m_~~ A A O o ~ o ~ o ~ O f~'D c~ rr N O O -+ II W N O O S06°21'19nW 345, r (N06°p2'21nEa 346,26 O) ~ r- ~V ~~ ~ ~ (,Tt c°on ~^y N V 7 7 7 V f~D ~J V S f R> lli W ~ F cD fA O ch cf r Ol 7 W W .., o ^ • ~. X l~ C ~ j ~ ~ a ~ ~F ~ ~ z a cc _ = c~ ~ ~ m o ce m a ~' o ~ ~ v ~ c ,_1 ~. .-,, MATCH LINE S00°37'02"E 808.42' ~ W _° O ° ~ ~ ~ V ~M ~ ~ ~ ~ •j ~:~ ~ ~i «w.d l (iy~ ~? °Sp 90. ?OS ~li~ '~g.JF ~r I`~ ~G Bearings are referenced to the west line of the SW~ of Section 26, assumed to bear N00°37'02"W. 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