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HomeMy WebLinkAbout034-1090-95-000 § ) CD w K 0 ti — �b =+ / \ $f �. ° SC)2 � 0k i ƒ$f J � j\}/ t. §D c i 00 ® 0.0 (D 2 ■§§ > '& kf$ca . LL \§275 exe c 7653 §S «_ L © \ B � 2 � . m § Cl) a m ° 2]/ §� kN \ @zz �a@ ° . - k 7 { D k k 7 CL «- 7E �a0) m Cl) ,Cc�E_ ) ) a,5 7 -� E = (D k }kk 3$e4t } t C } i \ O k / % ' § 0 a 2 « ® ) /\ k \ z a a a I V 0 U) \ u § § ° '\ § § \ $ 0 E o � _ § d c 2 b to z / ) . ■ % � ■ 2 ° \ k \ $ 2 :3 k * - a co ; e t =_ � a 8 8 § = (D £ ; © [ c = o k a i° @ e e 2 2 3§ 0 k/ @ k §\ f 2( . i c a 'M o 0 o e a f o CN m 'c � z/ z ■/ $ m I § — 3_. :..a Cd te E ] k a § & 0 a 8 U) v 0 ■ I s IM 0 o § ; i § ; ■ ° 4 � �i m ' M � § X // E o 2 w Cl) U E - _ + + \ U) ( P o © �' c o } } E I U t CD M 0 m @ / CL 0. E E - 4 _ , 0 > @ z > E a � ,, C CD; E c ,, � \ � 0� � � IL 0 § k 09 0) F: ° $ °g � !? � � � � �� • �. ■ z C 3 ■ ■ ■ 8 > � ƒ ) _ \ o � = m Z = �. } � cc 77 7 \ / G $ � ■ : E ® # m o w T E 7 g ( / 2 E § 2 Cn / k � � § 7 / C ; � ( $ � § - m � ; $ 2 I \ 0 % � CD § _ o § � . 2 � � � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 20 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: Village X Township Parcel Tax No: City Gailfus, Deea Springfield Townshi 034- 1090 - 95-000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic -ti J Dt Bottom Dosing ` Header /Man. Aeration I Dist. Pipe Holding } f f� I ) Bot. System (A . D. io ) Final Grade PUMP /SIP N INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 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 Bed/Trench Edges Topsoil Yes � No �] Yes L] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspect n #1: O 2 �► Inspection #2: Location: 720 Pioneer Road Wilson, WI 54027 (SW 1/4 SW 1/4 28 T29N R" 5W) Lot 11 Parcel No: 28.29.15.585 y 1.) Alt BM Description = 1 M J� 2.) Bldg sewer length = - amount of cover = r -- — - - Plan revision Required? J Yes 1* No Use other side for additional information. _ l L -J Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN G p In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] Hudson, on, WI 54016-7710 1 54016 -770 ,ago (715)386 -4680 Fax (715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: Property Owner Name � 0 1/4 5 1„i 1/4, Sec Z 1 T L N, R /-S� E (or) W Property Owner's Mailing Address Lot Number Block Number ` 7go T i arw'r City, State Zip Code Phone Number Subdivision Name or CSM Number 10 t 1SOn Q1 5q ax ° 1/S 77�— MG ✓5� 11 Type of Building: (check one) amity Village own of 1 rike,Ild FA 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): r t iA �e ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) w,"Jer- Ay Parcel Tax Number(s 1.❑ Repair 12.0 Reconnection 3. ❑Non- plumbing 4. ❑Rejuvenaton��g g Z 9 /� A) 0 3 `(- / v a - - oao Sanitation a `p B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetiand ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating Other 4epK gg rar . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. Total Elevation I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks fz zo SO Z l ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A Llicense is not required for terralift repair or the installation of non - plumbing sanitation system. bees Name (print) Plumber s Signature (no stamps): M o. Business Phone Number ber's Address (Street, City, State, Zip Code) N III. County Use Only Disapproved Sanitary Permit Fee Date Issued I 7yV1_ Agent Signature (No stamps) K Approved Owner Given Initial Adverse ,(� 00 Determination © 3 ZC�C7 IX. Condi of Approval /Reasons for Disapproval: /I J 1e� (") [ j e. � r9e� W�av\ tppf<cJ;0kr `pr `�ie Proper Prrkn <4 i5 •Skbwigcf p er Co t \_ r V' ,re p Gc i ✓gym en- 1:5 oo. S dlti no�d r rA "fj*, er9ep%cr U i �,�.� la�cru�ev /�PP li �a� c` ►��� S�na �� ���o(e�e�. Le- fu '-fed whey, u.eedeJ_ ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r N r N■ Room ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 J _ (715) 386 -4680 EMERGENCY TANK REPLACEMENT APPLICATION STATE OF WISCONSIN ) ) ss. COUNTY OF ST. CROIX ) CITY, TOWN, OR VILLAGE OF: PROPERTY ADDRESS: `7 2 p P ; o t, < LOCATION: ;, ;, Sec. , T N, R W, Town of t+r!i% Po,rct,t , . S- 59'b ss '1 y 5 g c I, G,a;-ks , the undersigned do hereby acknowledge that I am receiving a sanitary permit to ins // f h emeeodhepe fin- y �4� k- without a soil and site evaluation, or eZistin4system evaluation, and private sewage system plan review due to inclement weather and health or safety emergency. Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and private sewage system plan review will be conducted by the deadline stipulated by the permit issuing agent, or as soon as weather conditions or circumstances permit. If the private sewage system is found to be failing as defined in s. ILHR 83.32(1) , Wis. Adm. Code, corrective measures will be taken such that the private sewage system complies with all application requirements of chapter ILHR 83, Wis. Adm. Code. Dated: 1 1 4 6I —� PROPER9LOWOtR Subscribed and sworn to before me .20- this I4, day of Notary Public St. Croix County, Wisconsin My commission expires --7— COMMENTS: l.) Soj/ �tS� 5kd.// ge fidom � al'rj - h /iJer AAv- J,JLIy ZS Zoal. I // I (r Z J p .S�cn 4 0, Z00 Javy Prrr s�G1�� �e op�a�reC� - �vvw— e �or.�v�4 o F tiCe ro JoLTev 'I 0 U,ASf J 3 � 7�ic SePTiC SySfr,�•� S�,Q�� 6t ih S�a ��c� uia � 't�y atr. aal�S'�' � �� ZDU l PLEASE RETURN TO ZONING OFFICE, 1101 Carmichael Road, Hudson, Wisconsin PRIGINAL 1358 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety nd Buildings in accordance with Comm 85 Wis. Adm. Code Certified Soil Testing Y , ounty Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 034 -1091 od , ' 121 Please print all information. Reviewed By Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ropey wner ropey oca ton Ir Gailfus, Deea Govt. Lot SW 1/4 SW 1/4 S' ;Z 29 N R 15 W Property Owner's al ing ress Lot # Block # Subd. Name or CS +1 , 720 Pioneer Road 1 -9 40 Hersey City State Zip Code Phone Number Cit Village Ig Town Neatest Road Wilson WI 1 54027 715 - 772 -4899 Springfield Pianeer Road New Construction Use: 0 Residential / Number of bedrooms 2 Code derived design flow rate B PD W, Replacement in Public or commercial - Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: Holding Tank only; soils lack A +4" F # Boring Pit Ground Surface elev. 105 ft. Depth to limiting factor 4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -4 10YR 3/1 - sil 2 m -c gr dsh cs 2f1m .5 .8 2 4 -8 10YR 3/1 f1 d 7.5YR 5/8 sil 2 f -m sbk dsh cs 1 m .5 .8 3 8 -30 10YR 5/4 m p 7.5Y 6/2 4/6,5/8 sit 1 m sbk dh - 1 m 2 .3 I F2] Boring # a Boring Pit Ground Surface elev. ~105 ft. Depth to limiting factor 4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -4 10YR 3/1 - sil 2 m -c gr dsh cs 2f1 m .5 .8 2 4 -13 10YR 3/1 c2d 7.5YR 5/8 sil 2 f -m sbk dsh cs 1 m .5 .8 3 13 -31 10YR 5/4 m p l OYR 6/2 4/6,5/8 sil 1 m sbk dh - 1 m .2 .3 " Effluent #1 = BOD 30 < 220 mg /L yd TSS >30 < 150 m /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please not igna ure Ub I Number Henry F. Grote - 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54t5 7/16/2001 715 - 233 -0398 Property Owner Gailfus, Deea Parcel ID # 034 - 1091 -20 -000 Page 2 of 3 ❑ Boring # Boring Pit Ground Surface elev. X99 ft. Depth to limiting factor g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0 -8 10YR 3/1 - sil c2d 7.5YR 4/6 sil 2 8 -16 10YR 5/4 IOYR 6/2 i I F-1 Boring # 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I ❑ Boring # 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I I * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 5 < 30 mg /L and TSS < 30 mg /L 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. SBD -8330 (R.07 /00) Certified S61 Testing 1- FwY�cw� • O •� GQr 4" 1 1� .3 L �Wo. 13• z �s -� OAK - WOO CEMETERY 4296 -1 N W 1/4 4 1 3 2 1 1 1 5 P � - 5 - 5�� I - s I 5 73RD m j / B 51 4 1 3 1 2 W i I I I U� CFO OSr 8 56�4C U � 1 a`��,;,Jsa 2 � Cyj� � A NN 5 E 3 2 $ 6 \� qoo s 9 0 v(. Zpgp - f0 114 -SW 1/ 9 W - _2 Q = 590 N 8 MILL Q 2 3 1 2 1 1 y 1 1 2 1 _ 006 ' co - - - L 5 1 8 ' I32 s 5 4 s 3� 6 � 4 I 8 6 l 1 7 1