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HomeMy WebLinkAbout020-1353-06-000 * . k . .1..1 A _6i ' . 'Wiscor Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 370235 Permit Holder's Name: ❑ City ❑Village ❑ T �wn of: State Plan ID No.: • Schneider, Daniel & Carissa I H udson T CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: do f 4272 tz t Ai 020-1353-06-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Aik , .5 /• .4, NeCet-s (/ / Z.60 Benchmark /e /61, ( 40 Dosing (4, 0 Po O Alt. BM I VW 11 76 Aeration Bldg. Sewer (o 4 (5 , / Ho di St Ht Inlet /d - ?5 MI 5 TANK SETBACK INFORMATION swAt—Ciutiet TANK TO P/ L WELL BLDG. Aventto ir Intake ROAD . -lei Septic 7 / ( 0 I Z f I 2_1 NA Dt Bottom 1/,2.4-3_ FS' /S. b.C' PC -6 Dosing - 7 21 Z i NA Header / Man. ,[ (,) -1-1 q, 7 Z �(; . 3,P Aeration _ NA Dist. Pipe ,st y .4. ( r Z p 11. . S SY S Holding Bot. System (`) */ /O" yy, c � � PUMP / SIPHON INFORMATION Final Grade (A �z � �`Y P Manufacturer j f 5 Demand St cover c/ , 414•7 Model Number (�' 1 GPM TDH Lift Friction System TDH Ft h� Loss Head Forcemain Length //o Dia. Zi I Dist. To Well SOIL AB _• RPTION SYSTEM r Z r 1 � 6,,,, �- BED / j '' H Width / Length No. Of T PIT No. Of Pits Inside Dia. Liquid Depth DIM • NS 7 S Z DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA Manufacturer: SETBACK AMBER v �``' � INFORMATION Type Of Mo e Number: , System: l tr,i3 . 0 ( Z 7 / .---- / i, h l/›.4 .. , DISTRIBUTION SYSTEM 9,er1 Header / Manifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 1 S i Dia. / (( I Length 5 ( Dia. Spacing � I / VI— I Al/9" -7 75 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over 1 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.) Inspe #1:4 /3 / OInspection #2: / / Location: 85 Wilcoxson Drive, Hudson, WI 54016 (S 1/4 NW 1/4 36 T29N R19W) - 36.29.19.2006 Cottonwood Ridge - Lot 6 1.) Alt BM Description = + p O ) 0 A %, /h r _ ' 'r' 2.) Bldg sewer length = (2- ter it tl UI PIA-4 Ille o Area- 5 o-7 - amount of cover = 7 to / Gaud a re r It; 4 ..1 ;// 6 7 (,�,/ .) 1,(41 id 4);,--e,{ Gul c Lsic ✓e eqty pre b /cm. 5 to< Sy 5 66 e .,o,„ - Plan revision required? ❑ Yes ❑ No Use other side for additional information. , SBD -6710 (R.3/97) ` / Date Inspector's Signature Cert. No. �`' "J / fr o.. v i • 1' .5,.i hin if re yr Svfle^ 4v A Unt".`' 4- 1:4"91 S' ADDITIONAL COMMENTS AND SKETCH A. 9 . SANITARY PERMIT NUMBER: E m 1 i ; . , , , ; f ; f 1 _ ._„_. .m ,. .. w ...__. .._ ...... Wi t.... ........... .......,..,._. s .......__ e ... } .._..,_ i _. �.., .__., ...,.. '' ........_.?_......__, .-I 1 • • I 1 4 1 1 i 1 ] 1 , ..- --1- + 1 i f al i fl i i f T 1 , .. [ . ,. e 4;_11,.. . . al _.1....,_.,i_........r.. 1 1 1 10 I . , i L J. El 4:_,,,,i, i m 1 ._ 1 _, t „.„...„,... , 1— I i 1 H -11-0 4...._4_4.... ,... - 1 " . . t 1 ill imailini i : limi t .1 . 1 Ilim 1 ii par 1 al 1 . iiii ® 010 1 1 iii al 1 .....t, : __,..„_, : t__ _ l i r . ___1,..._ ii 1 : . 11 . . ,...: 4 . till pl 1 IIIIIIII 111 III 1 r ii 1 i 1 1 f__ la . 1 Eh- . . • i __ • al : 1 . s 4 _ 1 Ilaii .,.......,4___4_„._ ....,.,,...„. . • II ai II • II 1 1 . • __ 4 _ • 4 � I 1 _ « i au IMIIII t ; 4 _,,i,„,__ [ 1 1 - I 4 : 1 1_1_ 1 1-- , ,_,. : , t.,,..,_ . 1 • , , . , • . . iiimiimm ... ..._ _....... ........„... , ....t.. _ 1 , . . 1---- 4 . • • r rt...., • 1 iii. • �.m iiiiiiiiiii r . 1 IIIIIIIIIII �"^� ¢ lil Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. N V See reverse side for instructions for c tang this application PO Box 7302 seonsin Personal information you provide may � ,s dart' purposes Madison. WI 53707 -7302 Department of Commerce f ' (Submit completed form to county if r [Privacy L , .; state owner Attach complete plans (to the county copy oiil .. the - 1 .. 4 yy •apel'ot'ss than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number / ck 1s ■ , Lrevrouc a cation State Plan 1. D. Number Sic y, i k 3`30 1 5 i, I. Application Information - Please Print all Informati ii!if7. 0 /, fl06 Location: Property Owner Name - Property Location T CAcilX J/� SC h .) /E'dC Y j uu's.4;frOCE .S 1/4, .)1/4. SKTonN. a E (or)&13 Owner's Mailing Address � : .. T Lot Number Block Number 7 ?3 /- - ethev il ea iCaN. s,-�'/des- T - 1!� �y City, State Zip Code P . , 0 .• Subdivision Name or CSM Number PA< Jir.o.vf 117A- 3,S GG' ( ) Ga77 1,) IJda d P d0 II Type of Building: (check one) ❑ City ❑ 1 or 2 Family Dwelling - No. of Bedrooms: '7 ❑ Village O Public/Commercial (describe use): qZ)_Town of O State -owned Al 4_ I 6-4.4) III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A, / i d C z' eC 4,e A) 1. (it New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System d a ef - / 6 - Oj 6 B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Ilt 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 Dispersal/Treatment Area Information: 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. /day /sq. ft.) (Min. /inch) Elevation d ge 75 7Sd . F ,e/-- 9ge- SS 97, O VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks P(' /0d7 kf ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ p 1< . T50 1 fY1,A.)e ii VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS sho . the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): nir PRS No. Business Phone Number it} ' /(iCz Hi. sc Au. m &APr .,u�, 1 a2 O dd _7(5 --3/ Plumber's Address (Street, City, State, Zip Code) /i74 S c c i - e r f ' , / 4 - ei .c t ,/ C,J , �4 yG7� VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ❑ Approved ❑ Owner Given Initial Adverse Surcharge Fee Determination 1 :., CO IX. Conditions of Approval /Reasons for Disapproval: • SBD -6398 (R. 07/00) ('n;4 C, PUMP CHAMFER CRC55 SEC A.kJG SFECJFICArIOKIS ✓CUT CAP 1_ 9"C.T_. VEST PIP APPROVED L�JCK10.iG WEATHERPROOF �^ \ JUASCTIOAS BOX MMJHOLE COVE, z5' FROM DOOR, WIAJDOW OR FRESH I2 "MIU. 'T"' AIR INTAKE i I GRADE y le ! i y . MtA]. 4 /� * WNW. COA�DUIT � — — —1 1 1 INLET PROVIDE 1 I - - -- AIRTIGHT SEAL I 1 l / I / I ( E * f A 11 I I i 4LLARM a � *APPROVED 1 ow JOINTS WITH 1 V. ELE FT APPROVED PIPE 3' ONTO PUMP —� OFF . 0 SOLID SOIL V CONCRETE BLOCK RISER EXIT PERNII'TTED 01..1 IF TALIK MANUFACTURER HAS SUCH APPROVAL SEPTIC +r inapilzkiha ONS DOSE TAIJKS MANUFACTURER' 11/4 -)t 374e4-'[J NUMBER OF DOSES: y PER 0A TANK SIZE' PD ri GALLOWS DOSE VOLUME ALARM MANUFACTURER: A eL141ar 741 IItJCLUOING 6 ACKFLOW= �; r GALLONS MODEL NUMBER: Dl /J CAPACITIES: A= INCHES OR fah/ . GALLOA►5 SWITCH "'WE: 942 etc, B= a- IAlcHES OR z /2 GALLOA:s PUMP MAIJUFAGTURER: 6-a ', / / S' ` C = * _ tAILH£S OR J27 GALL0kTh MODEL 1JUMOER: -lc�= 1� D 7 c� i11CHES oft /i CALLOW. SWITCH TAPE: h> // IJOTE: PUI P AUD ALARM ARE TO DC MIIJIMUM DISCHARGE RATE 4/() GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 51 FEET 4- MIIJIMUM NETWORK SUPPLY PRESSURE - FEET + / »d FEET OF FORCE MAIM X 2 402- F i or FACTOR FEET TOTAL D'3IJAMIC HEAD • H.O FEET INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ---....;LIQUID DEPTH SIGNE �- -'`-- LICENSE NUMBER: 22 '79 �� DATE:�g Safety and Buildings Division �/! 201 W Washington Avenue WC' SANITARY PERMIT APPLICATION P O Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 - 7162 • Attach complete plans (to the county copy only) to 1- )vs - • ,.'QWtrti , a. -r not less County than 8 1/2 x 11 inches in size. -` s CYo e' K • See reverse side for instructions for completin• • - pplrCat[!Q(1!E \ State Sanitary Permit Number 1R�[� \ -�, 3 -- d 23.5 Personal information you provide may be used for secondary . ■ • . ses ; �Q® ID Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. M p, 3 FNS � State Plan Review Transaction Number I. APPLICATION INFORMATION - PLEASE ,,.T T AL - 1.,:11 MAT s Property Owner Name `t �n1 • paro ovation /, /� A-.✓ - S'CA414 o- 9) 1/4,S T q , N,R`f E(or) Property Owner's Mailing Addrss 6 Block Number 7'? 17Q `A e.-v7 8 1, (i. City, State Z ip Code Phone Number ubdivision Name or CSM Number - IT S(P .f/. � In � ar 'S B ./ ( ) � � ❑ � zlov l�aT4 i E OF BUILDING: (check one) State Owned / ❑ V City N ❑ Public 2� 4, / J 1 or 2 Family Dwelling - No. of bedrooms ( Tow ge OF t ..d ' '4/ c V Fred C,.. -,l e III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 6zo- /353-04 -ovo 34. zR. /4'. 2 04,6 1 ❑ Apartment / Condo 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 on line B, if applicable) A) 1. _j New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Tye 41 ❑ Holding Tank 12 kl.Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit L / S S 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 Min. in h Elevation Required (s . ft.) ft.) Proposed (s . ft.) (Gals/day/sq. . ( / c ) q q p Y q q o , / 93 sS 0 7r � � / � ✓ �� Feet `� U Feet Capacity VII. INFORMATION in gallons Total # of Manufacturer's Name Prefab Con- Steel Fiber- Plastic Exper. New Existin Gallons T an k s Concre strutted glass App. Tanks Tanks ptic Taa)k oaialdiny Tank X 44.0%// otG e g f e y , r{ / ®„ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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) M MPRSW No.: Business Phone Number: ‘ /, 5,4c. -M-r‘e (;);1 -- 2279 7/ s r3 1Cz-t Plumber's Address (Street, City, State, Zip C de): / � (� / 6 6 � . (Rat 4 n ll .f /Jr ' ,') o /L. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 2 2 -�OO 747 ‘.. anti, X. CONDITIONS OF APPROVAL / REA,ONS FOR DISAPPROVAL: * 9(t,wi v is 4 ues -,`4 iitri- ca, (Death.+. :..r re440,... 6 ,, it .7 &-,e —fdi( 7 .57 1 • d ht y�6 /4f t ,,, 4 4. �w / 9 r012er . ' k g0 1 - 4 ■9 X , 4, / e a e s p y - . . lu r kt « 1 /(/-7(.,' .- 4 1rerr` /4 Co,cy. . SBD -6398 (R.12199) DISTRIBUTION: -Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at 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 beproperly 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 is to oe 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 plumper 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 these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 1. Sc, eetr...r 'r en ;.4J L-J d AI`s_ - . .../3/n 1 Eie &( /40. ' 0 6tz de, .3.5` , S'4dh— / ` - S_G 1 A 4/ p1, r b s,• r ...._ . n � lam_ A- -5-x 7 Tr' cle' S .p L ; i, e 4 9 ;Li e ,,,,• 4 ` ) drop . li,rfhy doS< 70 \Vt 1(1 .S 6 64 1 r`a s/et l4 % r�"I w( Y /prior ,gyp t G Q pa / rr d l /ao e pl r rµ,,dpcU�'s+.� .. � fr r'4n„ G.. 4 A erkccr'A - Lr y e1 a 5. A Y r / � % 'a7-7 7 9 F d 3 -as"�o U d Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page l of 3 ' '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 Tess 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 S 4, c_ ,, ),_. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Revi wed b Date _ .---- Personal information you provide may be used for secondary u oses (Privacy Law, s. 15.04 1 (m)). ‘76(6 Property Owner Property Location — '41i - / �� ~�� ~U 1 " 4/ti cam, „-,-e .,r- Govt. Lot Sw 1 /4 ,jkf 1/4,S 3 (p T Z.9 ,N,R / / E (or) & Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 7 / 3 5 L. o c,, '7 o - w-e - & Ccs (viv oo dL 12 :A City State Zip Code Phone Number ❑City ❑Village ® Town Nearest Roa eaSt.rn-ouY■ 1 At/ 1 55x(9 56 1( ) 1.1 c) I w ■ l r C Cc IL- O New Construction Use: EResidential / Number of bedrooms y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (9 0 O gpd Recommended design loading rate , bed, gpd /ft • 7 trench, gpd/ft Absorption area required TS bed, ft 7 trench, ft 2 Maximum design loading rate • `? bed, gpd /ft Y trench, gpd/ft Recommended infiltration surface elevation(s) 9 3 • 5-5--- ft (as referred to site plan benchmark) Additional design/site considerations 14 , q 3 • 15 Parent material l)v -(-c. ) S' Flood plain elevation, if applicable wt./ 14- ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill - Holding Tank U = Unsuitable for system ® S ❑ u 2 S ❑ U ® S ❑ u 2 S ❑ U ❑ S ®U ❑ S ®' U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench ratwafi . i ,fix 1 0 -111• Y r 3, • tU / Z S:i Irma(9 Z i- M.-Cr C-S 1u-C . ' . 3 ✓ fit.,.:., , ; 2 iz `! s ' iv , / ryP( — _ s 1 )-m‘bt. rr..-c; C 5 - ,S, .4/ Ground 3 ` /S- -roq Jol r "f /& — M. 5 (s 6, l c S -- . 7 . , g✓ elev. 9745 ft Depth to , limiting factor - - ' /CM in.- Remarks: Boring # - I a) S”, 16* /2 `' S I 61ma be Vr-c r CC f b C 1 ,43 is z S:1 wu-c, GS — , 5 : is' -��l �vYr y/ �.5 1.7 . 8� 3 •� r1 / /a .-- 111,S w Ground elev. ' 5n. , Depth to limiting ' factor 4 17 in. Remarks:. CST Name (Please Print) • ature - Telephone No. av1ti cG 71.UwIc , - e- r' —..► --- 7/S= z4/7 e Address Date CST Number Z l/ 3 5 -5 4 - /I'C)2 /.&f' G✓'r- S 5- ,3 r 2 -act Z-5 3- 3° 7 a 1 PROPERTY OWNER s 4, I A , �c r- SOIL DESCRIPTION REPOR Page. Z-df 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure D /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots G P Bed ; Trench U - fL ‘1ov(3 /(- — s. ) Iw.c. ✓n.-c L 5 j .Z :,3✓ 2 to --112 i o1 r L / / ‘ - / £,' ) Z v► b l & r V \ c , ' c 5 . s : , C / Ground 3 / /K/6, elev. NZ' 1 ��' . PI S U Sc� VF't C _✓ 9 % ft. Depth to limiting factor . I — 1/0 In. Remarks: Boring # af 1 (r/(• t w3 /Z - S;) In,ab: war' LS Iir4 ,7 ;,3✓ f Z. 16 Y ,� 0 y /� � . s /�s fir• C� - , 7 :. X/ 3 YZ -flo ./0y r‘176' — nAS c) ,n, l S — . 7 . - 3 ✓ Ground elev. 1175tt. • Depth to Al '�3 . Ss , limiting 'Cl). y /P6 y+ factor I/O in.' Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 o_ly Iol � j (Z -- 5 ' I lw a('_ ty4r' c_s IuI .7,, ,3 51 4 Z )y-5O .,0 //q — L3 toss v1 Ce CrS — 7, , 1✓ , . 3 A,' - 1 v ( (-/ /6, Y S 0 `sc n " L Q. S " , ;,A' Ground elev. 97.95ft. ' Depth to a� fi r / limiting Se 8 °' , factor C1:3 in. Remarks: Boring # 1 0- /y- /0 / z -- S.1 lwiabL ko-cr CS lvC .Z ;.3 > Z Iv -l. foyry / 3 Qzp •S /b S ( 7mabL v'-Cr CS - ,,..5 .6 / 3 57-N6. /uv(1/6 v►l S OSn vyi ! e_S ` , 7 , j,✓ Ground elev. 911.0c) ft. 45 93, 5" Depth to -"We �� limiting fa for Remarks. / 13,54 /7,6 43,0/, % 5 lGLf // a -,e /- ,C,,',0rt SBD -8330 (R.9/98) PAGE 3 OF 3 NAME ay. 14,ti, LOT# LEGAL DESCRIPTION S6,1 '/ J' /4,S ,N,R/ ? E (or)W SCALE: 1"= „IM 1 ELEVATION / • c) BMI DDESCRIPTIONtop o-F Phore- pcatas{u( S, �J • `. _ BM 2 ELEVATION /00. 35" BM 2 DESCRIPTION ec k t3dX 5.E c- • G. SYSTEM ELEVATION 3. S S ALTERNATE ELEVATION q 3. `15 CONTOUR ELEVATION 4/ v? _ Se at'e ': r• e „9 }' / ss 4' �° /• o Bq � ze • (3G •‘ t et,:o y o k cA. C.:(c{k SIGNATURE -DATE 3 -72 —C)o Wiscc' - fsift I SOIL AND SITE EVALUATION ' Division of : Page of 3 Bureau of Ir n accordance with s. ILHR 83.09, Wis. Adm. Code q Attach coml /2 x 11 inche�i P lan fnus ' �� County include, but erence poipt ($M nnA�,,a ), directiond �� .-1-. C Ct 1 k 1 percent slog � ' a (I I location and distanc a e to oad '\ Parcel I.D. # F. APPLICA nt all nformati on -. 1Rev' wed by Date Personal information you provide may be used for secondary purposas (Privacy Law, s 15,041) (itt. + frkal 4 i Property Owner . /Rfpperty Locatto f' C. rel. S C) r ti6 Qt 5 } 1/4 i(f(.J1 /4,S3 T Z ,N,R t q E (ore � c f_ Property Owner's Mailing Address \"' .Lot* . \bI k# Subd. Name or CSM# 1� 3 4 v k � .3 , - -r . ` �` ' ` ` e v. kro -etdL k._1' d.. -2 ❑ City State Zip Code Phone Number City ❑ Villa g e ® Town Nearest Roa Nvasor∎ 1 wt 1 Syv /(c 1 (7/S' )S'Y? - 6 )3( Poaso 1 C rot 0 N New Construction Use: ® Residential / Number of bedrooms _3 w4 Addition to existing building ❑ Replacement 600 ❑ Public or commercial - Describe: / Code derived daily flow gpd Recommended design loading rate • S bed, gpd /fi • CO trench, gpd /ft Absorption area required /0 bed, ft trench, ft 2 Maximum design loading rate '.S bed, gpd /ft . 6 trench, gpd /ft Recommended infiltration surface elevation(s) Sys w atA.0 , 9 7. 6 0 ft (as referred to site plan benchmark) Additional design /site considerations Co r. - krcrr - 1 2-( eu. 9l'0. 6, O /� Parent material (y- IO-C.[ ck- 1 d U - kJOL,S k Flood plain elevation, if applicable All to 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 [1] s [] u ❑ S m U ❑ s © u ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I i 0 -ly ld S,' I r wl-C C.S 1 -P .5 • G a tY 36 1 0 ry/`-1 _ , .s i I �f►Notibx m- C-3 . - .s''' 6 Ground 3 arc - `fz. 7,.4 r y /'j CZP ZS yr /h L. 3 �ls bK N'�� -'� c. S ' ' , <)/c) elev. Depth to ' limiting - factor ' 1:x_in. ' Remarks: Boring # 1 y a -t 4 lD r 3/z S; I 62ma,lik V» c r C 3 1 C •S G 114-3a la ry /(-I S,- I gmck 6 k ,YN-'r C 5 - ..c 6 3.- 7.5 r z.'7,S / 5L krsbk view-C: C 3 — .G ', i Ground elev. 76, 7C t. Depth to - limiting factor 38 in. Remarks: CST / Name (Please Print) / Sig .ture Telephone No. , / AG <SL `1 r 1 fno�. k P r- - _ ,C - 7/C -- - 0 V4 1 7- 7 adY Address Date CST Number 4 1 e i - C 6 2 . - . r — " / . , ` / S ot.e r CJ 1 s--4/006- 4/-6 -77 9533 9 PROPERTY OWNER c 3 SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 o —rZ toyr3/ Z. —' S ( a,+mabk h'Cr- C-S 1-� •S�'. r- ivyry /'4 S ( e'w abi; ►4r CS .dr 6 Ground 3 a4,- j67( Li/Li W6 St- rylsbk r'4V4: C. S _ '�° ,c1/o elev. 9(9 Depth to limiting factor __in. Remarks: Boring # ........................... .......................... ........................... .......................... ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Pal 3°4-3 " -(001 )e- (3 1 "%a. I 1 1 S" e 1 vv. e1-V. IOO•0 aM vJ V Od Pa1.1 �ItcJ (0 Sys+e,4,. &kev. 9 14O Con -vvr- el,o . 9 1p 0 • &M t- Ala rkh. 41- s +r•.. �nf ca , -- 1 v O slog V% ' > 1 a 1 • • S c .4. 1.-1.-- ta-kir SA VI JS" ST CROIX COUNTY S EPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer p c�.Y1 P � �' S S cte Mailing Address - 1 1 L w l v . o Se_ wt n v ✓n ry , s S has Property Address 4S5V W : \- ex JCS a - D k 5 © V\ C S I (e (Verification required from Planning Department for new construction) City /State l (Ac(S d r tA-9 Parcel Identification Number '- 0 (p LEGAL DESCRIPTION Property Location 5t, '/a, IV t■. ' /e, Sec. 3 , T oZ`t N -R t W, Town of t h . Subdivision O't v1 U- O6t1 Z d�c P , Lot # (V . Certified Survey Map # , Volume , Page # Warranty Deed # (O 05 1 a 9 , Volume 1 4 /3 S , Page # Spec house ❑ yes Eiito 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. I/we, 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 statin: that your septic system has bee i maintained must be completed and returned to the St. Croix County Zoning Office within 30 day/ f the i ee ear expiration &a-. s //O/OG 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) the owner(s) of the ope described above, by vi a of a warranty deed recorded in Register of Deeds Office. / d -5 /C9/ SIGNATURE 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 lb e , . , • 1 ii STATE BAR OF WISCONSIN FORM 2— 1982 i . E. CDMD 1. 29 i WARRANTY DEED ,1 KATHLEEN H. WALSH REGISTER OF DEEDS „_. DOCUMENT NO. vol. 1435PKE 16 i ST. CROIX CO., WI . _ . • - - I RECEIVED FOR RECORD i! RICHARD 0. STOUT and JANET P. STOUT, husband i O6r17 MOUM h and wife, i 11 i WARRANTY DEED II I ! EXEMPT I 1 CERT COPY FEE: conveys and warrants to DANIEL C. SCHNEIDER and COPYHM: CARISSA J. SCHNEIDER, husband and wife, I TRANSFER FEE: 137 70 . RECORDING FEE: 10.00 h 11 PAGES: 1 i! 1 1 !I i .. ;! II THIS SPACE RESERVED FOR RECORDING DMA .. .. . . .. !NAME AND RETURN ADDRESS 11 the following described real estate in St • Croix County, li , State of Wisconsin: il ' ll i■ 1 i Lot 6, Plat of Cottonwood Ridge, Town of :d Hudson, St. Croix County, Wisconsin. d :! 1 d 1, ii 020-1110-20-000 1: :I PARCEL IDENTIFICATION NUMBER 11 II ., ; 11 I. I I State of Wisconsin 11 ii County of St. Croix . i. il ll I hereby certify that this Instrument • I a tut true and correct copy of the docu i on file and of record in my office and ,- been compared by me. . ! ‘,„ 04 Attest 11 1 t Kathleen H. Wal - , -,_ lister . da F ! fr• !: ! 11 Thi is not homestead property. it (is =1 il Exception to warranties: easements, restrictions, rights-of-way and covenants 11 of record. . , !! Dated this lath day of June , A.D., • .. . 1i Richard 0. Stout (SEAL) Janet P. Stout (SEAL) I ! • Ntka, i& ( Eirua sdlglIMP, (SEAL) MAO 11 1 II AUTHENTICATION ACKNOWLEDGMENT !. :1 Signature(s) State of Wisconsin, l l • ss. It St. Croix County. ' 1! authenticated this day of , 19 Personally carne before me this 14th day of i• Juno , 19_94_ the above named ;. • • .. TITLE: MEMBER STATE BAR OF WISCONSIN A.. (If not, h Wi s. 6 by IZ r . i.;. 4.1 authorized y 170.0, s. Stats.) , •. 4 t. if, ', nown to be the persons__ who executed the foregoing ll • rt ent and acknowledge the same. 'l THIS INSTRUMENT WAS DRAFTED BY — 0 / ,I II ■ Janet P. Stout !!'' STATEC*. : 4,A yaw - 6 , 1. 1353 Awatukcc Tr. ...! Hudson, Wi. 54016 Nota the, ; Coumy, Wts. it (Signatures may be authenticated or acknowledged. Both are not My , • , mission is permanent. (If xot. state expiration date: l: 1 necessary) ., f -.. Narl1W0ipe7S;;;;VIIni in 2111y c;pm:Ity shouiri41ypec1 or printed below Liver signaturei. "''' STATE BAR OF WISCONSIN Wisconsn LAO Bark Co.. Irc. WARRANTY DEED Form No. 1 — 1982 1.40watkie, WS. ... Mot n kg-4.; 'tea tJ * ''A .H r „ f 1 LOCATED L THE NE f// OF SECTIOI N89'56'47 "W 795.82' --------- - - - - -- 403.52 ---------------- - ; � - -- 138.18' - - - - ?i • N I �/ �� i i W1/4 CORNS' I� :. ' I i SECTION 36 i ^ �/ r .' / ' ; i S88'46'38 "W i u � , / i r S-4,- ' N 6 ;•; 7 i �a 1 q'O : i i N 2625.80' ! I ^b' / / /o a / 2.039 ACRES 1 1 ti 2.019 ACRES �' , 88,810 SQ.FT. ! _, !, N 87,970 SQ.FT. .4•11; � ; ,.�1• �! 8 a z i ; ii f i M I / / + ♦ ./ r_.� i n i i CU I :; 1f i �N7• i / , ."\ p 1 •.• ••. •.4:J / ini r• :U, i / N89'49'59 "E � J ! ' ; 0 3 i 8 _ .. ..T .- - - - • ` 1• -_._ L ▪ i � . M r • i 2i z 333,0000' ENER ❑ �' -�, ' 4 / ':849'5, f;t UL- DE SAC ��, C4 `�`•. i•. ! r ,o - -� / ' • 2.025 ACRES • 1 J -? k _. ( • • 88,213 SQ.FT. - -- ` . ` r� S ii • Q I TE %"� MPORARY CUL -DE -SAC ;•••.•''••.'�. / \ / �3� w i� EASEMENT � '•`� . l N�0 A ' ' Em I NOTE: •... ', SAS• \ 'S Em iN CUL -DE -SAC TO BE REMOVED ;' r ` � �y -i I UPON ROAD EXTENSION , • �"� •y� .: • I 2 .034 ACRES 9f' ` , • 10. A5,3 - i 88,624 SQ.FT. \ / i,' • - • • I �> • • % N89'49'S9 "E 416.66' ' ' • .,,.•••'' r ------------------- -------- - --------- � i i I / /, 4 1 1 i i I 1 I , / . 1) . • i ' I / • " to i ' ._._.�._._._._._ on :� 2. 023 ACRES 1 W Ire ' • I • r 20' DRAINAGE . • iccu N 88,107 SQ.FT. . �.1. 66' cv p i _._._._._.a._._._ EASEMENT ..... b ' �'� 1 ` O j 5' TYP. j I j r i __ __ _� __ __ __ _N89'49'S " _ _ ! i 10' \ 10' TYP. 1 1 I j I I 3 5' TYP• i - -i ice j Q j I O 1 I . 4- - - .-.-.....-.-._._._ 10. i N 2.001 ACRE v � 87,165 SQ.FT. " -- ,•% 0= Q L -• - - _ _ N89' i 12' TYP. --al ...-- >•-• G -- 12' TYP. 1 - 1 • L -- -- -- -- -- - N89'49 "E 390_00' J n ! 3 I j T W i I j . _ 0 • 1 1 ' 2 1 P1N 1 1