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HomeMy WebLinkAbout020-1363-20-000' n~n0 3~0 C7 r~ Cam. ~ 3 A O C O ,' ~ '3 eo A7 `+1 i D 1 0 ~ ~ M ~ ~ ~ 01 lD (~ ~ c . M ~ 7(n ~ N y Q w CNO ~ ~ F~1 ~ 0 . +~ ` T C ~ ~ N a d ~ Q N ~ A N N ~ " n W=~ ~= o ~ O ~ ~ o ~ ~ 0 ~ I . `3 ~ ~ v D C .O - a n " .h~, ' ~ I ~ - IW w o ° I ~ ~ ° ~ o ~ W a v ^~ ~ ~ o o oo~D ~ w ` ° ~~ O nrtn ~ Q ~~ I m 3 ~ i ~ ' ° I ~. a ~ o~~ , OOOy', .' ~. a 4 -~' fA ~ O '', ~ N m ~ I o (- j c ~ fn fA fA ~. ~ _ ~ 1 ~ ~ W ~ l9 d N I ~ 3 ~ ~, y Q ~ ' .. y ~ Z ~ .~ ~- N Z~Z o I =~ o D m ~ =_ I -~ s . ~y ~ I ~ ~ ~. ~ c o m w m a c _ m a ~ ~ p ~ N O ' C A ~ A ~ ~ =~ ~ d A Z O ~ ~ ~ I ? I I pow Z ~ N m~~ eo ~. Z ~ A ~ p c~ G < y < Z ~ ~ I o~v ~ a I ~ ~~ ~ . ~ . . ~ ~ ~ ~ ~ ~ I i ~ o v m o o. T y~ ~ Z ~?~ N O a O y. tD ~ O~ y C I °a a ~ ~ ~ ~ _. -I ~ ti „~o r C .» N O I ~ O ~ a I I o 'b : v ro A ~ ~ :~ v~ O ~., `' a o ~ CD o ~ I a o ,., __. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFpRMATION (ATTACH TO PERMIT) Personal information you provice m~y-tre sed for se ndary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ~ ^ City ^ Village ^ Tgyvn of: Westburne Su 1 Inc. ~. ~ Hudson Township CST BM Elev.; Insp. M Elev.: BMLDescription :/ , i / r TANK INFORMATION ~~ TYPE MANUFACTURER CAPACITY Septic s Do ' A ~ n Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic ~ '~ ~' ~ ~ NA A Aeration NA ding PUMP /SIPHON INFORMATION er Demand Mode! Number TDH Lriction SYs TDH F orcemain Length Dia. H Dist. To we SOIL ABSORPTION SYSTEM ~ ELEVATION DATA County: St. Croix Sanitary Permit No.: 363859 State Plan ID No.: Parcel Tax No.: .1 ~ ~ 3 . Za.-tea 020- f$'~3-~6=699~- STATION BS HI FS ELEV. Benchmark Z . L Z Alt. BM , Z d 2, do `I Bldg. Sewer sl. "` t' G Ht Inlet ~,~ 9~- f~ / Ht Outlet ~, Z om Header! Man. ~, ~'~ ~'~_ SZ Dist. Pipe ~ rt f R Z ~ .~ + ~ L Bot. System !`' ~ ~ R z 9S~ ~ Final Grade St cover ~- ~ Da , BED / C Width ~ Len th ~ No. Of Trenches PI No. Of Pits Inside Dia. epth DIM ~ S ~-- DIM SYSTEM TO P L BLDG WELL LAKE /STREAM L NG Manu acturer: SETBACK CHAM INFORMATION TYPeO r ' - ~ "'-- OR UNIT m er: System: Env ~ DISTRIBUTION SYSTEM <<~'"~~+'~%h- ®~ rilad ~aS~/~N,.~ 33 ~ QOC~) Header /Manifold u/~ Distribution Pipe(s) r ~~ ,- x Hole Size x Hole Spacing ' Vent To Air Intake Length Dia. ---~ Length SQ! Dia. ~ Spacing 2 '2~ ~ ~ Z Z y ~ S 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: ~ / ~ / bVlnspection #2: / / Location: 639 Brakke Drive, Hudson, WI 54016 (NE 1/4 SW 1/4 27 T29N R19W) - 27.29.19.2157 Exit 4 Business Park -Lot 20 ~`` Zd 1.) Alt BM Description = 5r~ 6r c~ooV g•~~OCw-,~.r!ocr S~.r,~eo~ ~t '~ y s~""" 2.) Bldg sewer length = ~~ ~ ~,~~ ~„~// !~ Cwt {~ ~,~ ~ -amount of cover = ~ 3a' rNsa~,~c! i,,,,~ ~' ~lU C ~ ~ ~ `oo v C !.{rr:t Tr: 6 y~%fiy-- ~~~al. 3.~re I,vt~~ ~ ~/°h/a~/ `(, y SS/ 5-~Gw~ ~ 5 n S7~a,(~d G~l.c~ly Plan revision required? ^ Yes ,[~} No Use other side for additional inform ton. SBD-6710 (R.3/97) X pl~fhn~Aj SkMr.+D~ ~~ ~a~/ Ohf ~1o~tf-• GkfGs/~i/ ~Z2rI r1 ~- ~ / Da Inspector' nature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~ ~ ~ ~~LA-K Kam- ~ ru Cam. `~SC011S%11 SANITARY PERMIT APPLL~ATION Department of Commerce In accord with ILHR 83.05, Wis:-Adm. Code r • Attach complete plans (to the county copy only) for the system, on ~}p~bot less than 8112 x 11 inches in size. .~~Y~:,V~` • See reverse side for instructions for completing this application ~ ~`" ~ hY, `'L'~~` .~ ~a ~, Personal information you provide may be used for secondary purposes r~ , [Privacy Law, s. 15.04 (1) (m)]. ~,',. cs~ ~:\ ~•~~~+ Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 d E$' , ty ~r ~ ~ /' S anitary Permit Number ~' 36~ ~S~ k if revision o previous application Plan LD..Number .. ~ ~ ~1 1. APPLI ATION INFORMATION -PLEASE PRINT ALL INFO RMAT T W = Glf S I . r°`" ' Property Owner Name !~B 7` .w 2 ~ "` ~ro~erty.lpca)4, iiy ~y ~~. ? T 61 !~ , N, R ~ ~ E (or)4AV Property Owner's Mailing Address ~ Lot --' Block Number / (~ ~, City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE IL ING: (check one) ^ State Owned ^ Ity Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ^ Village /~~/(/ Town OF Ss ,d /~+',y~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) /) - n Q • / ~ ~ ~~~~ , ( " 3 G ^ aG 1 ^ Apartment /Condo ~ ~ d "' /a ~~ 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 ________ Existin~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 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 (,Seepage Trench 22 ^ In-Ground Pressure ~ • 42 ^ Pit Privy 13 ^ Seepage Pit ~ ~ 6 3 ~~ 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ~~ Requ red (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation U 7 Feet X30 y Qr 9~ ~ Sd Feet ~, S ° VII. TANK INFORMATION Ca aut jn all0 S TOtal # Of Manufacturer s Name Prefab. Site l s Fiber- Plastic Exper. . N i E i Gallons Tanks concrete uct tee glass App ew x st n st ed Tanks Tanks Septic Tank or Holding Tank QL d0 ! Q ~'`P(i.t/ ~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Stamps) PRSW No.: Business Phone Number: !r>i' ~a. sue. .SCLi ~ ~c v lJ '' ---- ~ a ~ ~' D 3'- 3 8`rr - /.? l Plumber's Address (Street, City, State, Zip Code): io7e, s~a~ d so ,' ~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee. (1"dudes Groundwater ate ssue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) Z~ ~ Adverse Determination o X. CONDI T ION OF APP S E SON FOR DISAPPR VAL: R4VAL / R _ , / A - ~ 11 1~I Cn1F-tnt~ ~n~unT-i7.2 _ v~~LnO~ ~~ 2Pil ~ S ~~~ ___. SBD- 6398 (R.11/97) DISTRIBUTION: Origir~) to County, One copy To: Safety & Buildings Division, Owner, INSTRUCTIONS 1. 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 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 and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system isto 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 81/2 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; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. 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 thesesurcharges are used for monitoring groundwater contamination investigations and establishment of standards. .~ ~ ~ ~ Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Apri108, 2000 CUST ID No.267341 WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/08/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 187626 St. Croix County, Town of Hudson NE1/4, SW1/4, S27, T29N, R19W Subdivision: Exit For Business Park -lot 20 Facility: Westburne Supply Company FOR: Description: Commercial Non-pressurized In-ground System Object Type: POWT System Regulated Object ID No.: 657069 The submittal described above has been reviewed for conformance with and Wisconsin Statutes. The submittal has been CONDITIONALLY A] be met during construction or installation and prior to occupancy or use: Identificatio ers Transaction ID N 308431 Site ID No. 187626 Please refer to both identification numbers, above, in all comes ondence with the a enc . ..: ~ _ ° %,,~ ~ ``.. ,~ ,. ~) 1 r ,•- ~ ~~~~ i ~~ ~ ~ ~ ~ ~ ~t.~,~ ` r: f ~. (d Zj~ .... --__ ~~ l iiJ~ • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Codes shall • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • This approval does not include plans for the general plumbing systems or sewer piping leading to the sentic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • The plumbing for this project discharges to a private sewage system. The approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic/sanitary wastes. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. WEGERER SOIL TESTING & DESIGN Page 2 4/8/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, and M. Swim POWTS Plan Reviewer -Integrated Services (608)-785-9348, Mon. -Fri. 7:15 AM to 4:00 PM j swim@commerce. state.wi.us DATE RECEIVED 04/07/2000 FEE REQUIRED $ 110.00 FEE RECEIVED $ 110.00 BALANCE DUE $ 0.00 WiSMART code: 763'3 CONVENTIONAL SCIL ABSORPTION SYSTEM ~, ~ FOR Page ~ of '~ 1~~1 L S~st.k'S ~ w~~~v S ~. ~3 ~-p G , LOCATED IN THE ~~ 1/4 OF THE SW 1/4 OF SECTION Z~ , T Z~ N, R l9 W , TOWN OF ~OSOIV , ST•e1~~X COUNTY, WISCONSIN. LoT Z,O _O~ ~'X~T---~ijv2; BUS1»~S p INDEX Pape 1 of 4 TITLE SHEET Page 2 of 4 PROJECT DATA Page 3 of 4 PLOT PLAPZ Page 4 of 4 PLArd VIE~I-CROSS SECTIOPd PREPARED FOR ~J~TOV\~~ SUPPLE , 1 PuC ---tZ3~.._ __ l l~~V S`CTc1 f~-L --`~vo S~SV i ~1 ~ S ~.ol~ PREPARED BY ~;C ?' ~ ~ ~} ty,pYL~"~~y ~~,1~,i o " O~pPR~MSN~~~~./~~~1.~Y WEGE~ER SOIL TEST = hiG AN(D I7ES I Ghi SEFc V = CE F.O. BUI 74 42i X. KAIN S7. RIYEE FYLS. YI 54022 pis-s~.,-oia~ JOB NO . CEO - 89 y-S-6° - PROJECT DATA Page ~ of This conventional in-ground trench system will serve a retail sales and warehouse building with 4 employees, 1 floor drain and 268 sq.ft. available to customers. ANTICIPATED WASTEWATER 4 employees at 20 gpd = ----------------------------- 80 gpd 1 floor drain at 50 .gpd = --------------------------- 50 gpd 1070 sq ft of office area of which 25% is available to customers. 1070 X 25~ = 268 sq ft X 70% = 188 - 30 =6.25X1.5 = - 10 gpd TOTAL = --140 gpd The system is sized for 250 gpd which will allow for additional future employees and customers. SEPTIC TANK 250 + 750 = 1000 gallon minimum capacity required. A 1000 gallon Midwestern Precast tank will be installed. PLOT PLAN Page 3 of y SCALE 1"= L~~ ' T~l~Ffa~ PFD ~,~t" tom.) PtPE I ~ ~~T CuR,~1 5' 6Z•S' ~ ~ v~ ~ - ~ ~ ~_ =i S - - - -- s ' --o ~l o' •n~-cw~s ~-~.~c-+~s ~s~l~r a r~ sv~Fyy~c ~?2wt ~ ~ B...i- ~ CF Ctos ~ Wti2 t'Z-IOZ- 6 tTL, l o o$ P ~1~..`noti~ ~,~..~ u G 3~ s~\ ~~` d~~~ aw' ~~oPO sEo a t/o ~. " ~~~- To 3E ~7 L~`1t~~ST S CV ~ ~w~"1 '~1~~•~-f1'~S _ __ ~'t~D 14-fi LET Z.S' ~l^') S~~71C_ `T~~lz ~- =5~''4~1.C `Cf~'-J~ `Cp 8~ 1=llX~O Gf~ ~ ,_ M [ b;,j~;57i~ftw - - - ~L~N ~1 ~~,w . ----- ~~; ~~ 1 ~- y ~~ v ~ w~ A'P P`2c~vEp C~ C 2 \Z'~. ' p~ S' O- b `f'`PUC Pe2Fu2,}~ p~PE G2. s' CQf~SS SE~TIp N ~Zw n t rv, '~pvC l uoU G f~ S ri~~w ~~3T `f't~.1Yt y"pvC y `pvC 6 i? pip c SU 1 L laZ~ W14c X Ft ll. FYPP\z.ov~p Sk~s~-nC CpVt1ZWG ~. ,. „~ ~~ ~ i .T~"- OF ffZYo Z!!Zk f3GCtZ~T~P1'TE 8~-w~J ~jlS`l~Z.[pU`nOrv APR. ' 2~' Ba ~~~ ~3 :~ ~_ ~~f ~r ~T~~~~ ~~Y~-~~~ ff@pr}f1;FFE&E!t Of GOF~ltll~FCl~ ~~: tit-~ P. oaliaaz sateN and Buildings #QQ_3 N KINN1=1f COLA£E RO U1 CROSSE tlYl 5801-1831 TAD ~; t608? ~4-8777 vwwv..ataN.1M•ua Tg1i. Thomptan. Governor @rsn~ J. Blanchard, Spry Agri! 15, 2000 civsT ~ l~Iw~TO4~a _- fT~" - "HtJ~ON WI SA016 A1TN: ~idld~gs do F4trtrcru~es /NSPBCTOR MUNICIPAL CLERK TOWN OF HUDSON 988-COUNTY ROAD A HUDSS7N Vttl 54016-1628 lid tY~A~~~:_ --1 .Numbers . ~tlsucif~l-~ g ~~ namhet's. Site-1!pY~ ~'AI+L7~ -- =>~r RlY with the. Y. S~~iXCatu~y,'1't~trtt~i34lPSaH=12-3'I IhtDUS-TRIl-L_ 1~t7DSOi~1 S~7b Fes; ~EST6UKNE S~OCiNIPlL1r1Y 123Z'Ll~lt]UST&I,AL., HUDSON 54016 Ft3R _ t»e©dplaon~ItS4 - tr813~1~E _ .. 6584M- Neerplee; ~2},33~s~, Unsprinkkred. Occupancy (Business, Storage} - - >~ ~ ~` Object Type: Lighting Regulated Object 1D No.: 650429 !p Administrative Codes and-WisconSia.StaLatp~ 'r'- =° ~L1~~**s~ "~~ ~PPi!,41<A1~4bb1! d-1;'PROVED. The owner, ss defined in chapter 101.02EL0~ VltiseonsinStapues,- is respr-nsilde fur eocnptia~ w~i~h ail coda requirements. The fotlowfig wnditions shall be met during construction or installation and priortt-occupancy or use: • _. SCE SCI? _ P~io* ~ ' ~yl~tnn_ one ~~ ~t6e tn_etat_~i1 ~h s and~culetions shall be submitted to s 50,000 cubic feet, --eachset-e€-plans.:ha3!-bear. an ' ' ' red by ttrc building desirner C~'l'Tdtis~exieue doest~at` t~_ tionigr. The owner should be reminded that HVAC plans and calculations are required to be subm[ued for review and approve! prior to iioq. • CQMM33.12 Footings staatl.baper-ua'ased.sttuewcelsaleuletioa~~.iif!" ieatings) s-- 51.03(6} Exterior walls shall be non-combustible construction. No wood frame construction shall be _~~~1 dfar the ex_wa~_ • COMM 60.12(4} 1]tis_eal door not intrude ttu "future" tne~line. Msssaniue plena showing alt a~cal~le_code te_gpitetnent~sknll b~submitted before. it can 6e used fQr any_p~rpose (guardrails,~cit _ _ OBtfr2_Sb• tla, ~ttoff conga{s, display ' ste~itcla: teals-as raq+ttre by-cod4. s A copy oi'piarapptnvedplaps~spetificetiops-and-this Wtec sbatlbre;~o~e~tr~ag{~struotioe and open to inspection by authorized represeritotivos of the Dapartmcnt which may include Iota! inspectors. Alt permits Wisconsin Department oflndustry, SOIL AND SITE EVALU ~Q~1.3~~., Q , tzar and Human Relations , .; ~rvision Safety 8 BuikGngs e n , ~..LD acCnfd.with II NR R4.~Ir,. V4fic 4rim (`aria '<,,% Page l of 3 ~~~~~LS S~ ~ ~~ L ,~ Att mplete site plan on paper no than 81/2 x 11 nches in size. Plan rnUS1; i elude, Stet'. ~ ST ~ ~-~1X ---~ ~ not limited to vertical and horizontal reference point (BM), drection arxf''9'o of slope scalp a `RARCEL LD. # , dimensioned, north arrow, and location and distance to nearest road ' ` •~ ~ ~ Z!J _ 1363 - Z~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~a_~rv~~~~f~~` R IEWEDBY DATE 5~- PROPERTY OWNER: w ~5`C~vi21v ~ SL1`aP ~. t tv C _ PROPERTY LOCAT N -~@~t~OT -v~ , tra~J v4,S 2~ T 'Zq ,N,R ~9 E ( W PROPERTY OWNER':S MAILING ADDRESS. I Z 3'1 t- -.~ b ~ 3TCc.t (~- L LOT # - Z~ _BLflCK'~" - SUED. NAME OR CSM # R~1T ~ltZ B ~srn~ t~s CITY, STATE 21P CODE PHONE NUMBER t-~DSofv w 1 S .p L 6 h/$) 3f~,. SSZS (]CITY ^VILLAGE ,MOWN ' Sp NEAREST ROAD 3~-QcVz-(r~L, ~CZ- ~C], New Construction Use [. ] Residential / Number of bedrooms [ J Addition to existing building j ]Replacement [Xl Public or commerpal desrxibe '~,~~, L S t~L.lTS r'1'>`.A,> Lv p'(1, t,~E BLDG Code derived daily flow ~ 5 p 9Pd Recommended design loading rate - bed, gpd/ft2 - ~{ trench, gpd/ft2 Absorption area required ~, 3 y bed, ft2 6 Z S trench, ft2 Maximum design loading rate - ~ bed gpd/ft2 - `f trench olft2 , , gp Recommended infiltration surface elevation(s) ~l b . S ~ ft (as referred to site plan benchmark) Additional design/site considerations Z TR~~.1 cam- ~~ S'x. 6Z,S' I.oWG w/wtt1~ y,Z cx~t~tOtSt- ~ZpE?-s Parent material Ln toss o y~ o~'~wPs3N Flood plain elevation, if applicable ti ~ ft S =Suitable for system U= Unsuitable for s stem CONVENTIONAL MOUND t~ S D U ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE ~ S ^ U SYSTEM IN FlLL HOLDING TANK D S ~U I D S ~ U SOIL DESCRIPTION REPORT Boring # :•-:..Y:r~.::: ~<,.: ~- .~::.~:~w;:. ~. v .~y~{ ~. }~~+-t.i J h ~iJL: Ground elev. tol.gft Depth to limiting factor ? f fQ" Boring # 5.t ~ v ~._„. t Ground elev. t IQ~.' ft Depth to limiting factor ~ L~-Z" Horizon Depth in. Dominant Color Munsell ~ Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence ' I Roots GPD/ft g~ rerxfi ~ o -S l o~-L R z lZ - s i ~ t ~ ~? 1 wt`~t^ ~ - IJP - 3 Z $=Z0 ~•SK2 3~y - G~-s( llnSbk wl.`Fi- c~, - •~{ .S 3 ~-4U ~-SK~i~I~ ~ 1.`FS ©39 Muffs- cS - -5 ~6 4b-66 .~ -S YfZ 4~/6 - 1~5 o s ~ M v'{L1- C-S - '3 • y S 66-t.to ~.S~2~1~ - l~s os9 mvfl^ - .s 6 CG-v n1 S ~ • S `1 R ~!~ L3 ~, m V `~ V ~ ~ S . IJOZ' C o . 8 ~ • 0 -c~ ~-: - Qo.,,~.i,~• 1 o_q ~o~t tz.- ZLZ - . s i ~ z~sbk ,y,fs- cs , S ~ ~ 6 Z a--i.s~ ~0~2~6 - s>> Z`~Sbk m~ ~s - .s .6 3 t~ =Zg ~~s~rZY16 - is o sg ~ I ek, _ .~ . ~ ?~•3g Z,S`1231y - S$G1- U Sg -Yt ~ cs _ ,1 ~ .~ S S~ yvp`~; fl'S •A'r ~ 1 ~ -8 ~?' `~~ Ba --c.~~~ Remarks: STName.-Please Pnnt ~ Phone: _ Arthur L. Wegerer _ 715-425-0165 ' ~egerer So' Testing & Design Service-P.0. Box 74 River.Falls,Wl 54022 ~' .• signature: Date: CST Number:. • 00-89 y..-3-00 22025~- PROPERTY OWNERwQ518~ZAJC Supp~,y SOIL DESCRIPTION REPORT PARCEL I.D. ~ O Z.U - ~3 h3 _ZA Boring # x2:2 ~:;;:~ 3 :x~~; .< ..., Ground elev. a~.6 rt. Depth to limiting r )tqj 6 a Depth Domin t C l Horizon in. an o or Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Botxiclary ~ CZ u ~ 1.~ ~-tfZ Z _ s i I 2.`f ~b rn`F~- cS 3 2,u 3b ~-S~nUI~ ~ ~ 1.~sbk 1'-'t V`F N CS `~ 36-~~0 ~ S `I 2 fly - U'~S) ~~ t'Vl U `Pt- CS S ~6 ~q6 ~-. S ~r2 ill, _ ~`~S o S 9 -n V '~t~ 3 S sue, ~- 1 ~~-~- s ~ } nernar-c s: Boring # ~~~~;~ ~ z~~~ I o_~ t o `~ Q Z t z > ~;:z 3 ~S _zy ~..5 `-tR Sly Ground elev. IW.Stt. Ly-y~ ~-S `1 R V~~6 Depth to S ~~-108 Z -S `1R S/Y limiting factor ~,~~ S S~,wt~, NAY y >!OS Remark s: Boring # . : ,.. >k • > t .: 3 ly_2u ~.S Y23ly Ground elev. bZ. b tt. z~ 3b ~ -S y R s/!6 S 36-i12 ~-S `t2Y16 Depth to limiting (actor 5 Sf~M h1UT~' ~ > l lZ'' . ~;• Z~i Remarks: 3oring # M~y Si:f ,=i ..+ti, ~; ~~A around ;lev, f t. )epth to imitin 9 actor Page?- of ~~ Roots GPDlft Bed Trench .S ~~! .S _ .3 .y ,~ ,y ~ I `y - GrS 1} Z`~~b~ w,.'F1- ems, - , s ~b l~ c~ S `~ m U `Fl~ e S ~ ~ 3 f . y `Fs c~ ~g m1 - ~3' .y A-g Y~•T @ i - s i 1 Z~'sbk m ~~. cs -~ , S ~.b Gr 3 ~ l -n s b k wy ~~. Cg . l{ I ,. S ~~ 'Q S 9 Y~ l~ 'F ~ - , ~ ~ ~ ~ p~I' ~ } t Z ~C.uT o r~ ~o I r rcrrrarr.J `h rr •r •rnrf~ .~r ••••, r ' PLOT PLAN ' SCALE 1"= Lf ~ ' ~t -~. 10-.6' orv 1-oP of T~l~ !tu ~~ p~ Page 3 of 3 6~1 -t`1. lpp.O~ ON ~" ~~) P t PE LpT CoR. I LL Ala 6 ~ S' ~S~~~T- ETI.. \ 01 ~ a. - _ __1 ~o' ~ s s Z-s fi~1 V ~ r }~ $~ 7 ~_et.lUly LL D ~ 'r1~-CWT-H'~ ~'~i¢~,C-~'L"~ ~~~ r s ntiwt ~ ~- ~-IOZ.- 6 ~..lu o s ~+~zw u G _ ~'1'WD _ -4-T_ LET 2.S' ~t.1-^'1 S~'1~`r1 C `fY1'fv~ -: ,- ~O-S~ __ C~ z2oZ S ~i ~• ~"3'~~ ~ 715 ) 4?5-(1'I n5 CST Signature Date Signed Telephone No. CST # ~; (~_ 1 Bureau of Integrated Services ~~ ~ accordance with S. ~ ~ Wis. -Adm. Code Attach cmmplete site plan on p ' r not ~ n 8 i 1 k~es in ~ i rust ^~ °°:~'~ ~~ include, but not limited to: ve ical and ntal refs point•(B , dir Cfiby! and ~ ~ ~,~`:} ' `~ percent slope, stake or dime s arrow, a catio ,fo'tieare,~t road. Parce! LD. # ~ .may ~ ARPLICANT CNFORMATi4N -Please print a(t informafid+rt: = r c ,_ . Reviewed ~i+. Date Personal intormation you provide mary be used for seeonddry }wrposes (Privacy Law, s. 15.04 (1k(t~.`y U Property Owner PropeAy Location ~ . ~ ~,~r-as .~..~... fat ~r~~lia~ Govt. Lot $o~~,.tia,~,,p 1r•~,s~°~ T,~~ .N,R ~~ w Properly Owner's My~ailing{-Address p L^ot # BlodcM "Subd. Name or CSM# ~j C~ ~, - (~!~! ~ ~R.S~Q4"t°~ A.Ue.n.~ ~ t~~ .__ ..._L.~ F ~ ~ ~ta~., ~ rt4.5 ~ ~~r t"~ City State Zp Code Phone Number ^ ~y ^ yUage ^ Tpyy~ Nearest Road S#~~~1w~~x~ ~ s~o$~ (psi ~ q3~-`s~fl u~.d~a~, s~ N ±~ [~ New Construction Use: ^ Residential / Number of bedrooms Addition to existing building !, ^ Replacement Public or commercial -Describe: _ I Code derived daily flow~~ gpd Recommended design loading rate A,~_bed, 9pd/it~ ~~_irench, gpd/ffi'- Absorption area required bed, ft2 trench, ft 2 Maximum design loading rate ._~__bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ f"! ~~ ft (as referred to site plan benchmark) Addifiona! designts~te considerations Parent material 6 ~ ~ '~ ~r ~ ~ ~ ~~' `~ ~ ~~ ~~ ~ ~ ~. ~ ~~ Flood plain elevation, ifi app cable ~ ~" 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 # Ground ~~~t. Depth to frmiting factor f U.?° in. Boring # Ground elev. # b~~. Depth to limiting factot~ 5 t~ ~!G fin. Remarks: CST Name (Please Print) W ~~~c~ Address ~~~ ~~~i~ enu r''cCC`QtDTIr'1A1 Q~t~nl`tT Horizon De th Dominant Color Mottles St-uciure d R t f'P~ p in. Mansell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boun ary oo s Bed ,Trench Q~ -+~ 4 Q f ~, t ~- ~ ° ~t ~ f'~S~ t'~ ~ ~°' P r,~J ~, ~ t '$ ~ w ~ g rr , h F' ~~ .,E qd } ~4.3~ ~~~yr 4r~~ °'. S ~ ~ ~' ~ __ "'~ __ , F 2 V l ~ ~$~ - '~`$ fit, 7 , $'~tr' 3~ °° ~ ~ ~ ~ ~ "~ ~ ~(~ // #g~~ RPmark.~ Wf ~~1t~.CS ~'~ '~ ~ ~; ~ ~'~~' ~ 2~sbk ~r ~~ 2f .5 90' 5' r ~~tP ? -' j ~ ~ f`'lS Dk ` k"ni~1!" ~: S , ~ ~ , f ~ . ~ • S ~ ~ `d~` tm `.~' g 5 . ~ r~~b ~ Mai' ~' ~`~ •- . --R y Sty-~ -,,sit' S~~ '~n1~ ~ ~ ~ 3 ~* f;}~ 1~~ ".. "~ '" ,~ S ~.~ s W~ti Telephone No. Date CST Number • PROPEIiT'Y OWNER PARCEL LD.# Baring # `J Ground elev. ty ~.F~' _~• Depth to limiting factor ~_j~~ in. Boring # Ground el~-. tt~3~.t5.~. Depth to limiting factor `~~(? in. Boring # _~ ~ ~'` Grcwnd elev. 1 ate. limiting factor ~~ a~,. Boring # Ground elev. ft. SOIL DESCRIPTION REPORT Page of Horizon Depth in Dominant Color M t Mottles Texture tr LZt Consistence Boundary Roots 2 . unse l Qu. Sz. Cont. Color Gr S . Sh. Bed .Trench t ! ,,~~ r~ "- ! +~ t 0 C ~ l .°° 1 hn ~` ~ ` 1~~ F~ F 1'1,T t'~ ,~ ` C. W r ? 7 ~ S ~ f 'w1 ~~ -I`i ~.5 r 5f~ -- ~ ~S ~ ._ .~ ~? Remarks: ~ w ~ 1 ~: ~~ ~. r 5 ~ vas r ~T ~ W ~ ~ ~~ F ae~"s~-~r~ir ~ ~7.5 y r i!' ~i. -- ~ G-1N Io r3/s -- ~ ~r1SbL# rn~~ Cw Z~' .~ .~ 2 l~-,~O fv ry/~ -- S~ ~ zrhs~tl r~~r e~ I F" , ~ : .(O n-5fi 'I ~ ~ ~' f/~y - f s ~}.~ t~ ~ L .s - ~ ~ ~ ~~-~r, ~.syr- ~~'~ ~.. x -~ ~ 2rnst~k rvti~~r ~ S - .5 ~ .~ ~~- 7d -t .Syr s/~. .-.. 5 A ' aP1sb 1. +~1~r r f. S -- , ~-# : ~,~ Remarks: _~ w / lay` e ~.~ cry ~~'.~ -~ , S ~ r ~` ~/~, Horizon Depth Dominant Cobr Mottles 7Bxture 5iructure Cortsister~e Bounda Roots P in. MunseM Qu. Sz. Conc. Color Gr. Sz. Sh. ry Bed .Trench ~' I~ i~ r 3 l i : r~~b~ ~r ~.w Z~ -S • ~ ~ ~ °'~ ~ ~ . S r` ".." Ifs ~„ r.' ~~ TM' t"" 3tf ~r C 5 '". .~ , u I; `52 ~ S r .._, ~ S ~ ' ~. ~ `~ ~xw +iw ` iy d r r L". S .~ ~ , ~ 7 i rn ` ~ ~ /1 /. / ' p ` y~ S (r, I ~,7 -~.5yr .~.. ~ ~s r~~~~~ es ~°~ F ~d ~ 7° I ~ •~Yr -~ S -~ ids ~ v~~ - - y ~ , 5 Remarks:_.~ Wf ~Gye1tS 1 v~'S '7 .5 ~1 r ~.~_ ~h ~ limiting _._ _+n, Remarks: SBD-8330 (R. 07/96) 1432 12Q'~' STREET, NEW RICI-IlVIOND, WISCONSIN ?25-246-2454 Tam Nelson Cettifi~ 8oi1 Tester ~,"L'1~8'7-Reg'~e€ed Sanitar~n 8800713 ###+F############################################f##f############# '~ ~:~. .d ~~„ ' `; ~ f ~ is ~ ``- i ~ ~ 4~6 .L ~ P ~- ~~~.~ r b' '~ .;„ S~, ~- SCALE T" _ ~ ~ Tom Nelson ~# ~ ~~ ST CROIX COUNTY SL~PTIC TANK MAINTENANCE AGRBEMBNT AND OWNERSHIP CERTIFICATION FORM Owaer/Euyer l es~"'d u N.~ S Mailing Address 1~3~ ~<~~us 7~.~~ . ~u d s~ ,~_ Z~J ~` - ~ _.+. Propocty Address (Vedf:cstioa regairnd icv~a Pisaaiag Dqurlmeat far roew C:ity/State „~'~~ yr _~~ ~, Parcel Ideatificatloa Nwnbcr c~,•20 _-_~----ere- cxn~ ~~~sc~PTroN t 3 ~ 3 -"~ ~ ~~ ~~ Propexxy Location .GLC y, ~ Ys, Sec. ,~? , T~•R~W, Tows of „~~ ~ so,J Snbdiviaio~ _~ < 1- ~~ 6° <~s:_,pQ `~ _, .Lot # ~. fkrtifled Stuvey 11?ap # _-__ . . Voltmae , . psge # R~'arraaty Deed # ~.~~?~ % ~,r.__.__: Vohame ~;~-c 4~ Pogo # 3 ?~ ~ O Y~ ~ ~ Lot Baas identifiably ~yec O no • aiesodm:~mDedtaoaof~mr~:yabee:eoa~~daewlt~fo~p~eanwmfs~Wmmbsamer~e~e.rcoparma~oa~aoe of ptmop3o~ oat t1a sepHo tsaic pt~q-thaea yeas oc I:ao~+dedbr ~ ~oeasvdpnaoper. W6:x ~aa pat ~o ia:ysoem aa:ffiet•die • of the snpda mitc•u. a tr:OSt~pod oo;s b ~ ~~,popl.~mn. 1l~a poapetgr~ ogee ~ b st~mit'so St. Cools Zcoiq~ D ti ~eoa foem~ siymed by tha Qwme aad ~jr a 'P.'~l~~m~e,~w~obedPlaa~fxrar~-Eoeo~edfa~t4rial ~t(1~ lbe os~e ~a+vsoes'di~poat ~n ~ fa p~tnpocope~ oosa~tioa ~md/oc (~ alE~r f~peotioa sad poa~pias,(If neoe~q-}. ire tsairia ksa ~ I~3 III of . fly tba ~>tav~e,to~ tine abore ~ sad ~ b ma~bin tlua peiraee serape disposet sy~oem ~f- the iet ~i,1r~,•sa Kt by the DapsctaoAat of Gloamaa+x sad A~ Dapecomsot of Natatst~aroasoas, State of wisooasfn.~ Coca t5at ~oOC ~ysOem,bss beoamtioq~aadmmtbe e+omplabdseadrehreoedto die BL C~nix•Gb®ty ZodaB C~ffioo 30 days oaf Qn lhcee yesr ~tattton date, ~ ~zv~ ~~ ~ APPLiC~ANT DATB T (ire) vocttly tbat a1i sit an ffi3t foma sm tnu to t6a boat of my (o~nc) Jrnorvladge. I (rvc) am (use) the o.vaac(:) of the pity above, by vittaa of a ~rrusty deed teeoraed to ' of Deed: Qffioe. D~ ~ ~v o0 'lyRE OF ,APM:ICANT ~ ~ g ""''«"' Atgr mfasmbton tlttt #e m~-r+apreoaatedmty rewlt is the sanitsc~-p9~antt betag ravoicad by the Zoaing Dept "'«... •~ Iacladt MrEt6 t4ie eppttatioa: s asa~tod watrsaty flood $om tho Rog~+et Oil~oodS offtGO a Dopy of t8e cert~ed acvey msp if rafa+a~ce is muse is the watraaty deed t 620709 KATHLEEN H. WALSH kEGISTER OF DEEDS ST. CROIX CO., WI RECEIUED FOR RECORD 04-05-2000 9:34 R!I WARRANTY DEED EXEMPT M CERT COPT FEE: COPY FEE: TRANSFER FEE; ~37.14 RECORDING FEE: 1P.04 PAGES: 2 Raor~ing Area Name ^nA RNnrn Addrrss River Valley Abstract 020 1073 3D-000 Paned Idmtifica[ioa Number (PII~ "THIS PAGE IS PART OF THIS LEGAL DOCUMENT--DO NOT REMOVE" ~ '~~' 1JilOPAGE3Z 1 • ,+ warranty Deed ~y T7~n infarrnadon must be Completed by mbmigar: ~ F nt 71e nnmr k rrnrrn nc(. Jrui and P/N (V rtQ~flrrdJ. Ot6rr fnjormadon such ar the grandn j elaura, 4gal dacripdon, ere. nary be plaesd on rhG fiat page ojrhe deeument or mrry he nkerd an nddldnrvf nar'rr o/fhe a-..._ .... ........ . ~. j W?~..~~~OPAGE~70 '- ~ s a'oeuMENT No. ~~ WARRANTY DEED I *1lls a~nce eEeEFVEO eon RECORDING nnTn i! ~; ,STATE BAR OF WISCONSIN FORM 2-1882 ii ~, ,. ~•.._ . ~ ...~..P.T..,,.I.LL:,..a.Wi~nv~cin-L.lliu.t-~erl.Lid1J.],.LLt -- Y I'.cxtipany.......-- conv~Ys and warren to DJLC, LP, a Wisconsin Limited the following described real estate in ...$t....ALA.f2C-..._ ....................CounLY, State of Wisconsin: Ta= Parcel No: 0,20~-11 V" Lot 20, Plat of EXi.t Four Business Park in the Town of Htx3son, St. Croix County, Wisconsin. This .. is nOt ............. homestead property. ~}[) (is not) b Exception to warranties: F,asements, restrictions and rights-of-way of record, if any Dated this ...................'-----...~.,.....----.. day of ..__.-~ ..V-'.-...-..-..... ---'-'-- - -. i{~..2Q00 ...~~ ........... ,,.~.r{S£AL) .c~C~ttY...--~.t~K ........... ...... `EAL) ,~ .C.R...I3~cl~atozthy .............•------------.......-- " ---Paul..Wr.-Ha[nblin..I2......................---- ...................°- -....._....------....--------...---.._....... (SEAL) AUTHENTICATION Slgnature(s) _..--••------------------°......_...._....-------.._....._. authenticated i:hia ___._...day oi ........................... 1s1...... TITLE: MEMBFIt STATE BAR OF WISCONSIN (If not, --° .............°.-°°--........_..------------°-------- authorized by § 708.06, Wis. Stata.) '-. •.•- THIS INSTR ENTL(/~,~1~p\/l !AaS~p D~R~~AFTED B (Signatures may be authenticated or acknowledged. Both are not necessary.) ... ...................................................... • --(SEAL) ACKNOWLEDGMENT SPATE OF WISCONSIN + ~~~ ^` 59. ' •s}~n~Ily c ie before me Lhis ..~..~.....day of .~~?.~~-J--......, $902000 the above named .~. Pa T..~ LLC,._a.-aLgfYtIIS i n .I,iinitari_ T.i ahi ] i tY _-C..A.._ li3ck~di~t~.ty.~Ltr3.Pc1U1.1d... HaT1lh> ? n --II to me known to be the person 3)........ who esecuted the f~go^ing instr ent and a ~~ same. W{SCOlISI~- ~ • at f ...............•--.................... Notary Public ... .................. ................County, Wis. ri2y Commission is perma~ent.(If not, state expirati//o~~ny~~f date : ................................• °-~------...----~ ~~G4' f •Namea of Deraona alpnln[ in any capacity ahu+dA !K typed or nrinlcA below thrir nuenalurea. ~~ t9A nitA Nrv nrrn .4TnTb: non nn «'iG^ntJSrr• Wi%~~n.i~lanAl iliPnw f;n.inr: --------t __ ~~ ~~` ~ ~~ t.~ r~ ~ i'~,~ ;,~~ ~ ,~ ,.~ ssll . I i+ ~,~, f _ `. _ , _._ ~ I (~ 4 ~ II~ I t 4 -•---~~ ~t- --- .. ~ ~ ~ ~~ ` ~ J ,~. ~ ~, $ tai -a ~ x 1 ` ~• $ ~ ~ 1 g 1 ~ j _._._~_._._, ~ ._ _ _._ ._ ~ ~ ~ ~ ~~ .. ~~ f(I'' I y i I ~ ~ ! 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I ao `o I ~ I co i O I I I ~ ° ~ ~nrv O I~ I~ In o ~ ro ~ n ''"' ~' ~ w O °' N Irv w ~ I~ I• i~ I ' m ~ ~ ~ '~ ~ ~ ~° I° : r*i I ~ I cn I I ~ o zv t ~ ~ w ~ ,, ~ ' o, Itv ~ CO .r ° N ~ m ~ - I OD ap I ~' z ~ ~ ~o I I ro Z L___~ N 00.00'01" E 424.10' ; ~ ll w o N ~ ~ ~ I ` ~ D ~ o I II DRIYE ~, I ~11 o~ o• ~~i p ti ~'- ~'1 ~A I1' ~ 1 V L.~ r n