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HomeMy WebLinkAbout020-1441-80-000 ga c J J % k c C ° , i CO % 4 9k : 0 m E Z ° S 7 E* / 2 $ q a a % , 2 E« r 0 ® I k S E; § e 3 6 9 Q T , k § 8 2 2 0 0) 3 2 g - 0 0 0 0 ( / >0 / \ \ \ & o E % z / / 0,-u) i z z ° S S E E R cz z co 0 0 0 \ p 2 D % % § / $ 3 ■ ■■ o CO 2 ® g J.7$ R c ' — g A . = § £ .. 73 I Q 0 8. Z - k r / k > 0 § ) § § .. N E a 3 _ to 6 Jz* 0 k / z \ .. 6 ■ mfm o co k 4, 2 © ® 2 7 z � $ ® E, CD CA CA m> , B « EE 0. ]7 0 7 - § E 9 � I E ( c + \0 . oc % — o.a. 0 6 , m 3 =E ®a $ \£f ca K o +ES$ 2 \� / 3 A. z' 2 a> 03 { J a> 0- �k CO \$OI q . k .,O o O. C7 2 E 2 k K 0 § % \ A0 �A 0 � 2 Iv Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Di\;vion . 1 INSPECTION REPORT Sanitary Permit No 430284 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson Township CST BM Elev: Insp. BM Elev: BM Description: Secti /Town/Range/MKT 11:4 t u 16 2. / i il P G t- J t'1 tibL i'LGL'�ic.i(.h9/ f-,tT 36.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench /{ 1 t 2 j k -' r c.i,ti. Ly ilf /31Y1 ti ;,)- r Sts iu.-L/ J67/. / L= Dosing i Alt n --------) Aeration - -- --_., Bldg. Se r Holding / St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 5 - `iS (7 6) • Y5 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic ■ i/ � i Q"k C Dt Bottom Dosing - -- -_____aderan. 1 C17 '-( Aeration ---,,..„ Dist. Pipe s Q. 5! • _ r 7 • 5 Holding -. - - _ _ __ Bot. System b - 4` -� L __ ,�,fz l _ ;; 1 %y.G% J Final Grade PUMP /SIPHON INFORMATION 3. /o rig Manufacturer / I Demand St Cover \ C rkr1 V l GPM •7Z, /C>o - ,3 -G' Model Nun1r �. ____. __ TDH Lift )i>.tion Loss System Head W TD Ft Forcemair( Length Dia. Dist. to Well ac f Gl't j I . SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length / No. Of T.reAehes t ,l :) PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR �� �= Lf .� `�2 Type Of System: / 1 (- Lys / UNIT Model Number: C (NA. + 1 LAZlv.r 915 , G S d f r.- .id DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake a t( Pipe) 1 Length )1 ' Dia - . Length Dia Spacing - ..___- 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 sdif p 1 1 Yes No Yes ide-- COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 6 / (, / / (J` Inspoction #2: f / ` Location: 846 Wilcoxson Drive Hudson, WI 54016 (NE 1/4 SW 1/4 36 T29N R19W) Cottonwood Ridge 1st Add Lot 80 Parcel No: 36.29.19. 1.) Alt BM Description = 'v ;t .'• - 2.) Bldg sewer length = 9 t L 1 /tv'� "(" - 0- - 1 L. ' 1 - amount of cover = a,5/ , i;L " Plan revision Required? ! Yes n N n � � c , fit � 1 �J� Use other side for addit onaliinformation. i_ L _ g . `7 V SBD -6710 (R.3/97) \'l. - h t• ,, 1 L 1 Date Inse ctor's i nature Cert. No �N(6(( �7� /i ���tr• " x ,1 6. 1 1 7 `6, l't�t. �` �; i F,) ,t..-\.1. to- v. is ir'" tY'6 t - , ()11 - . "kY,lyytin '- 1 Aa.i , , ,,, __,;/ _:_71--. d.,,,,,,,„,,..1-- . . 7 .. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ( of li Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ° ().07 j X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /94/yt.Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed b ' � �`� Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G W� _�� 1 11 / �$� Property Owner Property Loca l l / LOY / g �° Govt. Lot,-5. 1 /4(, 44 S5 � T 3 - 7 a R E (o W Property Owners M fling Address Lot Block # S . Name or CSM# 19 . j 7 4 A cc,h, ' C a H-v-1-. , 1A )1_,c,r.,0 ad City State , p Code Phone Dumber ❑City ❑ 2Vill e�own Nearest Road y j / _� / fi /4 �. a .t. ' 1 UV a I L f /XP( ) I 1 PJ�7-- f— 1 P�T7 Go t [ 0_0(sJh�til,�cX )New Construction Us esidential / Number of bedrooms.5 Code derived design flow rate - 2 so _ GPD ❑ Replacement ❑ Public or com real - Describe: _ _ Parent material O 1.( / Flood Plain elevation if applicable 6/ ) ft. General comments and recommendations: / r J & Q r ) y joL?' CaL prod Sys - J r n9 Boring pit Ground surface elev. , i ft. Depth to limiting factor / 2. 23n. /E. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 17 arilliEW;g11 dr.. A._ M (s nal 6 � /' /iai ►l d2. 2) li is A, A M / h - I� 1 61 Co 1 = 6 2.Y`� 7` ,ly % -- 0 , A, i c ' 1. - 7 ,g.,/ " . / Boring # 0 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • _ > < 01 = B D < 30 and TSS < 30 mg/L Effluent #1 BOD > 30 < 220 mg& and TSS 30 _ 150 . Efflu #2 BO D, mg/L CST Name (Please Print) • O re CST Number Bird Plumbing, Inc. Shaun Bird ..„,..-----___ 226900 • Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401/ fa 2 .z3 715- 246 -4516 P • OT PLAN PROJECT Kernon Bast / A 'DRESS 948 LaBarae Rd Hudson Wi 54016 SE 1/4 NW 1/4S 36 /T 29 7 /R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 " DATE 10/2/03 BEDROOM 5 CONVENTIONAL xXX IN -GRO 1 PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1 119 # of chambers 36 BENCHMARK V.R.P. Top of Telephone Ped @ 102.1' ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark , SYSTEM ELEVATION 94.2/94.1' 5.5' below grade imp Vent i >6 „ Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts of Cover with 31.1 ft2 of Area Manual Version 2.0 6' Long ftlik 34" Grade at System Elevation I ,, f tt f( 2 -3' X 113' Cells Combo septic 40, 45 ►c Vents with >3' Spacing 9 2' 65 , B -3 12 , • -4.2111 ■ Pro 5 Bedroom House 95' .4 70' -' o B -4 B -2 :: .r. •:. Po- 113' To B.M. #2 Top 30' of Neighbors phone Ped, 102.1' Pro Town Road • • Safety and Buildings Division LUU y j e �- r s s 201 W. Washington Ave., P.O. Box 7162 c . / ' r t, 1 >c, ,ScOfSIf *. Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 3151 L f�L� State Plan I.D. N berr Sanitary Permit Application D A In accord with Comm 83.21. Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Addres (if different than mailing address) I. Application Information - Please Print All Information ()2,76J t'v% ,,,,, ,, "'"Y! Property Owner's Na me Pa Lot # Block # '1 0 Property Owner's M ailing Address_ ` $ ' Prope canon t � e / X4/.4 -.. ' r ) t I �ection b /Code A ):)lApne 3 City, State t P 1 l ; y N; yit(c:cille II. ype of Building (check all that apply) Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms f / / /l Li Public /Commercial - Describe Use Ace a" 41.L `` ,�� '. State Owned - Describe Use A/ST■ CRCs a/ I �R c EJCity _ ❑Villa ' 1 Township of �jrOr: III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System r List Previous Permit Number and Date Issued B. ❑ Permit Renewal L7 Permit Revision ❑ Change of ❑ Permit Transfer to New 1 Before Expiration Plumber Owner 1 apply) IV. Type of POWTS System: (C heck all that ' p - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Li Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter 0 Constructed Wetland ❑ Pressurized In- and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ R I 'L Recirculating Synthetic Media Filter �� °achin• Chamb Drip Line ❑ Gravel -less Pipe ❑ Other (explain ,Be e V. Dispersal /Treatment Area Information: ! 6 .5e r.S'T o. ~ Design Flow (gpd) l Design Soil A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Sys tem Elevati q S 4') �J ; 107 a i1 /1 � X95.7 f� t 610,0 VI. Tank info Capacity in Total I Number Man acturer efab 1 Site teel Fiber ' lastic Gallons Gallons I of Lints ;, j ; Q A 1 iI _/vo Concrete Constructed Glass New Existing wl��?i�^� i , Tanks I Tanks Septic or Holding Tank �mr_ • - c , �. _ v �. Aerobic Treatment Unit Dosing Chamber 1 j VII. Responsibility Statement I, the undersii . s •< - responsibility for installation of the POWTS shown on the attached plans. • Plumber' Na me (Print) ti � Plumber') ,i SIP /MPRS Number Business Phone Number j 2 Z • 7 i . . , - - - - - - Plumber's Addre ss (Street, City, State, Zip C.4 j i t . ' - — - V— - — 11- - - - —/ff '1 li Z/ / t A L . d .4 . d - i ( A A 5 VIII. ounty /Department Use Only � Sanitary Permit Fee (includes Groundwater Da Issu d • • .: • :ent Signature Stamps) Approved ❑ Disapproved f( PP P Surcharge Fee) �� �� 0 0 � ��(� j i /iE (_� // C'liI/(�- 0 Owner Given Reason fir Denial , IX. Conditions of Approval/ asons for Disapproval � �� 7 SYSTEM OWNER: - a 5 3.S1 ,0,01.vzJ yti2 G 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be m nntained as per applicable code /ordinances ,43-( Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size I SBD -6398 (R. 01/03) 1 PLO PLAN PROJECT Kerhon Bast I l DRESS 948 La Barae Rd. Hudson Wi 54016 SE 1/4 NW 1/4S 36 /T 29 ill 19 TOWN Hudson COUNTY ST.CROIX MPRS BEDROOM 5 Shaun Bird 226900 D ATE S S 00 CONVENTIONAL XXX IN- GROUNDDESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1650 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chamber. 36 ■ BENCHMARK V.R.P. Top of 1/2" Steel Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R. Same as Benchmark SYSTEM 4' below alp q ELEVATION 95.7/95 6 Vent • >6 „ Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts of Cover with 31.1 ft2 of Area Manual Version 2.0 6' Long ill& 34" Grade at System Elevation B.M. #1 /1 Rio - �°�� ksvoi„,(1, 131 61,-) pU 45' 2 -3' X 113' Ce with >3' Spacing Pro 5 20 ST 2 ^' — Vents Bedroom House , 65 B -3 12' A 00 Po. 1 ' ( - ♦ 95 0 113' To B.M. #2 Top of Nei hbors phone 1 0 Ped, 2.1' ; B -2 V ents I 30' Pro TgLn Road V • \A/ i I ccr sj 1 r/'l/'e. • I ' PLO PLAN PROJECT Kernon Bast , i t DRESS 948 La Barae Rd. Hudson Wi 54016 SE 1/4 NW 1/4S 36 /T 29 1 19 TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 i DATE" 0/03 BEDROOM 5 CONVENTIONAL XXX IN- GROUNDDESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chamber. 36 ■ BENCHMARK V.R.P. Top of 1/2" Steel Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.7/95.6 4' below grade Q. Vent • >6„ Standard Biodiffuser Plans Designed Using of Cover Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 6' Long I& 34" Grade at System Elevation B.M. #1 * 41 10' • 0 B -1 • 45' 2 -3' X113' Ce with >3' Spacing Pro 5 20 ST 20' ' V ents Bedroom House E-- 65' �� 12' \10) - A 95' \ e)-9) , 44 \ 4 0 4 113' To B.M. #2 Top of Neighbors phone Ped, 102.1' B -2 Ve nts 30' Pro T • vn Road V T WI 1 Ccr- - — y 1 rAJ& • r ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� � Mailing Address `t-o p . ia, /:,,g! 6 Property Address r (Verification required from Planning Department for new construction) Re City /State f3NDSat' / liNk2405✓) Parcel Identification Number LEGAL DESCRIPTION Property Location,.,r %., 'P `/., Sec. , T . N -R /9 W, Town of fir ) • Subdivision ammwoo eiD ( F404- 4d »i , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 70KfY0 61- , Volume a 3 , Page # 3 S . Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 sst s�hat o septic system has been '. , intained must be completed and returned to the St. Croix County Zoning Office within 30 ys of +. - year expira u.' .. te. / / , C', �I/ �3 SIGNATURE OF 10(t- P ICANT DATE OWNER CERTIFICATION I ) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of pe ribed above, by : e of a yJr31.: ty deed recorded in Register of Deeds Office. ew, SIGNATURE OF APP ANT 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 Maintenance and Contingency Plan for a Septic System 4k Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 Croix County Zoning St. y 9 715 -386 -4680 Pumper Tom Mondor 715 - 246 - 5148 Shaun Bird #226900 J,,21.35P 355 7cDE3E313 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00Pt1 and warrants to Kernon J. Bast the following EXEMPT 1 described real estate in St. Croix County, State of REC FEE: 11.00 Wisconsin: TRANS FEE: 2880.00 COPY FEE: CERT COPY FEE: PAGES: 1 Exception to warranties: all easements and restrictions of record. This is not homestead property. Parcel Identification Number(s): 20- 1109 -40 -000; 20- 11 -9 -20 -000; 20- 1109 -10 -000; and 20- 11 -90 -55 -000 Name and RAI n sus• t0: A parcel of land located in part of the Southeast '/4 of the E di n a ealty T Northwest 1/4 - ..: - _ ; . ' - Northwest 400 South 2nd Street 1/4 , part oft •east' /4 of the Southwest1 /• and part Suite #115 of the Northwest 1/4 o e out west 1/4, all in Section 36, ��/ l ,ki fson, W{ 54016 Township 29 North, Range 19 West, Town of Hudson, St. ' "I(�,r�' Croix County, Wisconsin described as follows: Commencing at the South 1 /4 corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north - south' /4 line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North-South line, 1977.22 feet to the South line of the North 350 feet of said Southeast '/4 of the Northwest 1/4; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County, Wisconsin. Dated this �(� day of ..14-4 , 2003. e,,,,c,9_52<)(.,7,_\ /* if Y vii W ilcoxson Mary J. W o on ACKNOWLEDGMENT STATE OF WISCONSIN ) F AY PUelh,i. ' COUNTY OF ST. CROIX ) � f - O‘ </ y fr, Personally came before me this day of 2003, the above -med Neil L. WilcoxolF d Mary . C r 'y Wilcoxson to me known to be the persons who executed th fo oing instrume - • acknowledge the me D EBoRAH A, - /� PRESTON * Nota Public y — _ My commission expires: b /� G �h1 ih 4 � 2 This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 Of 6007? Dr`i1Vo • KERAJvN /345 f 3 1�o.vNA 5 Ern /34. r — vise 14- BAR ere RD • 1/01So,", w/. S 1 !'a/ ( ' . , Wisconsin Department of Commerce SOIL EVALUATION REPORT / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code /� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Ctxxily r G'C 0 J� Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Sze, /3e../6 Lv -x- percent slope, scale or dimensions, north arrow, and location and distannn to 'lowest road. Please print all info rniatGE I V E C ' ' R -- ewed • / . • Date Personal info mstion you provide may be used for secondary purposes (Privacy Lew, s. 15. M �� - -1 f�G 1 (1) (m)). frI7O3 Property Owner ; ' Pr opert y Lora on � e /� S 4)5 /•L /Lc XSO,v ��� 0 9 200 q Govt. Lot -sue , / l4 S 36 T Z / .: N R / 9 E (or) W ;Owners Mailing Address f ST. CROIX C,uu d'I" # Props Ma Q 11 � , or CSM# ,p ,.. p f - 0 e , S'' / te Cry. ma y- A. ZONING OFFICE / ftt " - //,, ` r/d1/'- City . . State Zip Code Phone Number ❑ City ❑ Village ftZ) Town Nearest`Road / 0p5o,v to/. 50 (7 6 3 r .11 -x? #W<S° i h y A/ iti—New Construction Use: Oa Residential / Number of bedrooms 3-y Code derived design flow rate ysa - 4, or) GPO ❑ Replacement ❑ Public or commercial - Describe: Parent material /bE S s o ae ' s o t/ Oa 1'(/J.4 -4 Flood Plain elevation if applicable ' /' — — ft. General comments / and recommendations: • 4RE4 7 15 5/7/ F "P AV / 09, v ArD cou v,v 1'/o,v A-L p o- &v • T. s . 7€3 . /3,'0 d ; ffvs -fit.. au/5 . / s -2e- P t . 3 ) g # ❑ Boring Borin ® I / I Pit Ground surface elev. 1/ Q 0 ( ' ft. Depth to *moo factor >' k / c� in, So Application Rate Horizon Depth Dominant Col. Redox Description Texture Structure Consistence Boundary Roots GPD/!F In Munsel Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Ef►#2 / 0-7 /6 YR 3/3 — G / sbic A,,, ,'>e lit) 2 f . y . CO 2 7 /oyg 'la • 5 f/e 414 ) C5 t . y . Ce 3 Mil 7.5 he e /44, y, d e cs — r. Z � iral 7 / ' 5 AIME D, 1 ' 4 • --- de 1. Z . �_ ,'7 Y 4)14 -Fns di SL % .�� a,t AMI D # Boling �iI ) V Z 0 id Pit Ground surface elev. /d b . ft . : , to limiting factor 7 / b in. te r, Horizon Depth Dominant Color Redox Description Texture Structure Consistence :. ndary Roots GPD/ft' In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 'Eff#2 rm o - si ic y' 3/3 _ G /is 4e 4 4i7' , w 2 f . y - • 2 OM /0Y 111E111.11 5c 0721111EINI .c s h e- In • < 3 E 2 _ Gs 1' IIIM 7 z. 111111.011111.11 MN liMI • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgA- • Effluent #2 = BOD, < 30 mg&L and TSS < 30 mg& • CST Name(Please /Ca /3E/� r /��/ GLl Signature ��Cy 2 CST Number �.fi3'7 S Address j� -- Date Evaluation Conducted Teleph onne Number Ulbricht & Arsoci tes ' .P-` . 7...- 2O z- 7/5.3 e . i'/83 ',haw 3awa etitildtanh C55 O'Neil cid. Hudson, Wis. 54010 - A V Ni F o �- 0 • / /oy•y • S'e or No co-//9.° . I iiii . - 2 K4 3) - 13 . . 020.1 f. yo•oar° Property Owner /V �! L to l c o % sa / v o� - //b y . z o • o� 2 Parcel ID # Page o f # &Lap 7 l�' it G rou nd surface elev. / a ft Depth to limiting factor 7 in. Horizon Soil Application Rate Depth ( Dominant Color Redox Desaipton Texture Structure Consistence Boundary Roots GPDAT In. Munsell • Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ett#1 'Eft#2 ro'k /00 2 /3 . L /7 44175e «-- /f • r 2 2 g.' /(, /0 yR - 5/c. / fs4 .wt fe CS /7`' . 2 . 3 3 _ 6•3t, / ? $ 5 - / e - 4+1-747 a s . — , • s • . 3/.3 7 5Yr? GS /' , 4 Cs - • 7 /. 2. • I I Boring Boring ❑ pit Ground surface elev. ft. Depth to limiting factor • _ in. , • SoA Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsef Qu. Sz. Cont. Color Gr. Sz. Sh. t 'Eff#1 'ER#2 Borinn I # ° &w' ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • I I Boring # Boring ' ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soti Appltcation Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff In. Munsell _ Qu. Sz.• Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • • Effluent #1 = BO; > 30 < 220 mg& and TSS >30 < 150 mgA- • Effluent #2 = BOD < 30 mg& and TSS < 30 mg/I_ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. 580.6330 (R.6A6) • For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road Hudson, WI 54016 715 - 386 -8185 or 715-772-3442 . (-- -( i.... � �J strc P 'of/ *" 1-ap ,it• - 5 , d -, j.,,, � ' ffi a' r o / p0•p . Or . r ,y .; . e= ,iii o -e n1• j 5 1 . /3 3 A _ to -4 1ty v' ,_ -P 5 1 35 Spa 5 w . t ,4 Caps 5 1 1 y • - /13 �,.� .......... ...–. — _____ _. 1 8z 3a' Tor Lo 1 r L i itl.2 i3 4t et oiv RonOS� p � a✓�'9 09 .,2 , t AAI K • LOT 79 a , • • 4 • 2.85 ACRES :, , ' 115,337.92 FT. ■. •., L.B.O. - 1033.85 L�,O4 1100 \ v • \ 13 11. • ti 44 NO % \ ?: ...... : 4.0 „, X z N a % : Pgi gl■ ■ / / ENI ■ I .4 y / .1,4,'N E1/4 CORNER 5`� 3 Ol 33 33 I 'C. �.' /3C/ / N88 "47'01'E 2922.70 SECTION 38 89499W 118.87 • ' (1)4 r a LOT 80 • 2.88 ACRES • g, I N 1 Z 124,559 SO. FT. B.C77 0 11 I • w #. L. B.O. - 1033.85 • • O / ► I g *z% 40, 1 x`41 o ! r 158.87 , . _ WILCOXSON SON DRIVE -- - - - - - DRIVE • 1 • - 1• 7 'e. _ p : . - . . !, .:1 __.. i — . .7 — BENCHMARK N A '''''".........\_..\ N I 'IRON PIP Ft1ND 9 i 33' 1 33 i[ 1 5 . 13 •A, ♦. I 1 N USGS DATUM 1929 • W J TEMPORARY CUL-DE-SAC TO BE REMOVED • I : za UPON EXTENSION OF THE ROAD PER THE PLAT N OF COTTONWOOD RIDGE i' 1 g I ; of mrs LOT 84 .--a—.....4 J 1...�. ■ • fl ©9] 3 2.18 ACRES i 1 LOT 81 94,285 SQ. FT. i I • 6 � B • I s 2.08 ACRES 9 0,839 S0. FT. • , f • • - / •l - -- - - - - +` • • I 19 ' I X16 • 1 • • r L ,OU 6 N89 214.78' , \ / • N89"55'21 •E 205.13' c� • • • \ \ 1 5 / 17 • • -\\. .... 18 ...... ... ...v2./ .1 r r6L._ _ _ _ ............ ..... Q _4