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HomeMy WebLinkAbout020-1355-09-000 ST. CROIX COUNTY ZONING DEPARTME g AS BUILT SANITARY REPORT y� Owner Property Address So r-iel1 A(T" A V 1 . � ; f City /State Pc V1 --e ` /AIC- ` ST cRc7Ix - CO UNTY r V:' ?ONiNGOFFa. Legal Description:, Lot Block ` Subdivision/CSM # awl E d t /4 t /4, Sec. Z1 , Ta1N- RIq-W, Town of b QGAo �4 PIN # EPTIC Ti � ANK j DOSE CHAMBER -- HOLDING TANK INFORMATION • , Tank manufacturer F I Size ST/PC Setback from: House Well 7.5 PAL 7�O Pump manufacturer Model - Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: I.FA Width 3 Length G .z S Number of Trenches z Setback from: House 40 ' Well P/L Sa' Vent to fresh air intake Coy' ELEVATIONS 7, ° F DA Description of benchmark 5 % °� � 01V r,1 � �� f. ��� Elevation 1 • Description of alternate benchmark sV.� �L 1,q TPf-r 0 Al 1 7- -gg 7- Z° Elevation � % � q � f Building Sewer I i S - J Yj ST/HT Inlet I' ?V ": �� ST Outlet z' Z� ' �, 1 Inlet `— PC Bottom Header/Manifold Z46 �3� of ST/PC Manhole Cover 1 '' Distribution Lines ` V J 3 - ( ) Bottom of System Final Grade Date of installation /1 / M" Permit number 3 Y yf- 7 `j State plan number Plumber's 'nature License number Zz 3 w Date / / M Inspector Complete plot plan or NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference se oints to center of tic tank manhole cover. p p • Show alternate benchmark, if applicable. �/ZJY PLAN VIEW �2 - T2F_ A' G f • t,, i Q i t � U ��TfEZNI�iE C : , , . T7 9 t - a INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: ,Safety and Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No_: X v P Y seconda p [ (1 )(m)]. M579 Personal information y rovice m a y be used for seconda ur oses Privac Law, s.15.04 Per mit MILLER N ame: ❑ Cit n village Town of: State Plan ID No.: CST BM Elev.; Insp. BM Elev.: BM Description: tlUD t Parcel Tax No.: 0 00 � 020- 1355 -09 -000 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w �- l Benchmar l<K? 6,,S3 a , , YC Dosing ! /3 / 03..20 L tion Bldg. Sewer ing St/ Ht Inlet //, �6 3 , 72— TANK SETBACK INFORMATION St /Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Air Intake Septic 7,51 I NA Dosing NA Header / Man. Aeration NA Dist. Pipe 0 92, L4 Holding Bot. System 5 / ' 3 / .0 0 , °! PUMP/ SIPHON INFORMATION Final Grade /0.4 T±4 OS Manufac Model Number GPM TDH Lift Fr' S s TDH Ft Force In Length Dia. Dist. To well Z 6 ,.5.3 S SOIL ABSORPTION SYSTEM $ ENC Width r Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �'S [ DIMENSION S SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manuf tur r: S, INFORMATION Type Of CHAMBER M e Number: —" OR UNIT System: 1 4b 0161 9 /0 — DISTRIBUTION SYSTEM Header /M nifold $I DistributionPipe(s) x Hole Size x Hole Spacing Vent To Air Intake Lengt Dia- Lengt Spacing > 0C) 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 E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) I q i; LOCATION: HUDSON 21.29.19.1075,SE,SE 808 GRANT AVE — HOMEPLACE LOT 9 Ac ,-- Plan revision required? ❑ Yes (g No Use other side for additional information. I It I n R q SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e 3 ... ..., .... m w . a a b 3 ° I , .®......s gg d 3 } v i i ... ........ .£.. _ ,... i, °..e,..e, e ,,,.,....,. _... a .. ..... .... .. � t i £ 3 °p —° mm m.m m�m ,m ..5 4 e , ° t i , °e. e� E a- a .. ....... i a a _....�..w. .__._.. .. ��.... ... ... � a I € t � ..y,...._ W € E S E � t x ems° e Y L I i a k ---- _. . °_ ...,_m t r�v e e e , n SANITARY PERMIT APPLICATION Safety and Builgt n Avenue Division *L consin 201 W. Washin P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to th count copy only) for the system, on paper not less County C / than 8112 x 11 inches in size. S 1 /D • See reverse side for instructions for completing this application State eS Sanitary ( Permit Number tN/ Personal information you provide may be used for secondary purposes 06 Check evision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Qwner Name Property Location (U rk S£1 /45E_ 1/4,S ZI T ,N,R E(or Propert Owner's Mailing Address Lot Number Bloc Number City, State Zip Code Phone Number Subdivision Name or CSM Number 14 t*a N w v! 6 (38�) Z o 6C, II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity age Nearest Road Public 1 or 2 Famil C] VII Dwelling- No. of bedroo Town of Ll 8 �Rl V E 111. BUILDING USE (If building type is public, check all thatapply) Parcel Tax Number(s) 1❑ Apartment/ Condo a 0 2 - 0, / s . 9 0 0 6 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. (5tNew 2. ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an Sys -- System ------- - - - - -- Tank Only -------- - - - - -- Existing System - ExlstlnQ 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 ILe� E] N 22 In- Ground Pressure / 42 ❑ Pit Privy 13❑Seepage Pit .X /4F' 4T&9 a`x 3 X SG- � 43 ❑ Vault Privy 14 ❑System -In -Fill 3�rg $Q �•r' S( ()r W b S L VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6 S stem Elev. 17 . Final Grade O Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) !. 2.� Elevation , l; 3 57 Z . Feet I Z OOFeet Cap acit y VII TANK in Ca g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer r s Name Concrete Con- Steel glass Plastic App New Existing structed T nks Tanks IC — :�4 Septic Tank r Holding Tank 0� .`! ❑ ❑ ❑ El 1:1 L7ft ump Tank /Siphon Chamber ❑ 1 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbers ignature: ( Stamps MP /MPRSW No.: Business Phone Number: Plumber's > o V • 1 ' Address (Street, - Ciity, State, Zip Code)• C v 1 C k u 054D t4 W ( of IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuinglgent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL /ROI)IS F�ISAPPROVAL: �,� ql • a- A, SBD- 6398 (R.11197) 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 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 is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX_ County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches 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. W900" n Departnerdof Commerce SOIL AND SITE EVAL ATION Page I of 3 ,.,Pivision of Safety and Buildings ( — in accord with Comm 83.05, W is. Adm. Code AC.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County include, but riot limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Please print all information. 0a 1056 -90-000 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). R BY Property Owner Property Location O Miller, Sam Govt. Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 9 Home Place City State Zip Code PhoneNumber City Village ZTown Nearest Road Hudson Wl 54016 715 386 -2769 Hudson I Grant Avenue ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 ❑Addition to existing building ❑ Replacement [:] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdff .8 trench, gpd/ft Absorpti area required 643 bed, ft 562 trench, ft Maximum design loading rate .7 bed, gpde .8 trench, gpdff Recommended infiltration surface elevation(s) 91.02' ft (as referred to site plan benchmark) Additional design / site Considerations Addendum to report completed 5/07/99 verifying suitability of soil conditions at B -3 to depth of elevation 87.76'. Parent material Outwash s & gr. Flood plain elevation, if appl cable NA ft S for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ® S El ❑ S ❑ u ❑ S ❑ u ® S ❑ u EIS ®U ❑ S ® u SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Structure GPD� in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Sh Consistence Roots Bed Trench 1 1 0 -23 IORY2/2 None A 2msbk mvfr as 2f 0.5 0.6 2 23 -40 10YR3/3 None sl 2msbk mvfr cw 2f, Ina 0.5 0.6 Ground : 3 40 -61 10YR4/6 None s o sg ml gw 2t Im 0.7 0.8 elev 98-07 ft 4 61 -128 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8 Depth to limiting factor >128' Remarks: Z 1 0 -9 IORY2 /2 None sl 2 msbk _ mvfr as 2f 0.5 0.6 2 9 -20 10YR3/3 None fsl 2msbk mvfr cw 2f, lm 0.5 0.6 Ground 3 20 -45 7.5YR4/6 None Ifs Imsbk mvfr gw if &m 0.5 0.6 elev 99.x' ft 4 45 -125 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8 Depth to limiting factor >125' —� Remarks: CST Name (Please Print) Signatu Telephone No. James K. Thompson / -- 715 -248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 11/1/99 3602 1020 PROPERTY OWNER: Miller Sam SOIL DESCRIPTION REPORT ,ozo Page 2 of 3 .PARCEL LIDA 020- 1056- 90-000 AC.E. Soil & Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPDffl in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -7 lORY3 /2 None is o sg mi as 2f, lm 0.7 0.8 2 7 -22 7.5YR4/6 None Ifs 1 m sbk mvfr cs if & m 0.5 0.6 Ground elev 3 22 -28 10YR4 /4 None gr. A 2msbk mfr cw if 0.5 0.6 98.76 ft 4 28 -132 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8 Depth to limiting - - — factor Soil profile amnwxled to verify reater depth of suitable soil to accomodale lower system elevation lxw builder /plumber requirements >132' Remarks: —__ -- 4 1 _0 -10 lORY3 /2 None Ifs 0 sg ml as 2f, lm 0.7 0.8 2 10 -20 7.5YR4/4 None ifs 1 msbk mvfr cs 1 f & m 0.5 0.6 Ground elev 3 20 -28 10YR4/6 None gr s o sg ml cw If 0.7 0.8 97.21' ft 4 28 -12 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8 Depth to limiting — — factor >121' Remarks: 5 1 0 -13 7.5RY3/2 None A 2msbk mvfr as 2%m 0.5 0.6 2 13 -33 10YR2 /2 None US Imsbk mvfr cw 2f, lm 0 0.6 Ground - -- elev 3 33 -50 10YR Non s o sg ml gw 1f& m 0.7 0 .8 93.77' ft 4 50 -119 10YR5/4 None s & gr. 0 s g m1 - - 0.7 0.8 Depth to limiting -- -- — - -- factor >119 Remarks: Ground elev Depth to limiting — factor Remarks: -- 3 oF3 Sob a ►� ^�. U ■ y' (A "C3 FAX DATE: // -, : / /9�? TO: Fax Number: Name : �/i n FROM: Fax Number (7i-5 -qY- 776 Name: Number of Pages Including Cover Sheet IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: C7i f 2 Vf - 7 76 7 �z�o Pe). 75. FEB -01 -1999 01:32 PM A.C.E. Soil & Size Ekjal 715 248 7764 P.01 �cl FAX DATE; TO: Fax Number. (1/ S) 3 IZ - el Name: FROM: Fax Number: _ (74s 24l Y- 776 Name: s .-- Number of Pages Including Cover Sheet y IF COMPLETE AND LEGIBLE E INFORMATION IS NOT RECENED, PLEASE CONTACT: NAME: , TELEPHONE NUMBER: , s a V?' - 776 4low > 9 �• n• FEB -01 -1999 01:33 PM A.C.E. Soil & Site E"al. 715 248 7764 P.02 Wkm" DaPatkM a Conlrraelw SOIL AND SITE EVALUATION P -I- of ' ohmion of t3aklly and BalYdrlga In amrd with Comm $3.05, Wis. Adm. Code A.C.E. Sod & Sib Ltvalwdeo!' Mich oortlpw I►Ilo plan on peer nts Isss than 8%x 11 M>chw In slim Ptsn must county Include, but net INrtlted Inc vertical and horlalx*M tafww m POO (IPA), dlleetlan end _ St~ Croix penxnt slope, seals cr tlYrfanrlarr, oath arrow. and loodk n end distanos to nsnst read. Pansel I.DA _ 020.1 036A0-000 ,APPLICANT NFORMATION - Please p-k* ag lelornmdon. Penwnsl ihrormatlon you prv� My hs used ra aevondery D�+ t�"� 1�, s. 15.W (Q ( rn)). Reviewed By Do to Property Owner Prapslly Location Miller Sam _- G ovt. Lot SE 1/4 S 1/4 S 21 T 29 N,R 19 W Property Owner's Meiling Address Lot 9 91ock #! d. Name or CSW P. B ox 151 Home P lace 9 _l__.... _ -- City State Zlp Code PhoneNumber IL City vllage Town Nearest Road Hudson W1 54016 715 386 -2769 Hudson (irantAvmue New Construction : Residentlal / Number of bedroorrrs 3 E]AddMw 14 edit g building Ej Replacement 7 PW* or =modal dwribe Code Derived daily flow 450 gpd Recorni ended design loading rate .7 bed, gpol'fP -8 herteh, gPdhY Abso tlon, required 643 bed, IP S62 trench, ftz Maidmum design loading rate .7 bed, gpdAP .8 berc , gpdM R13cornnended infiltralion SWIM elevatlon(s) 91.02' ft (88.9b. 1110 SW plan btlnchmatk) Additional design / site conslde 81bns Addendum to Mort eompletl 5/07/" verifying suitability of sown condWwms at B -3 to depth of elevation 87.76 Parent maWial 0utvvash Saw. Mood elevol m, if s2m NA R S-Suj* for sygtern j Conventional Mound I"mund Pressure AT -Grade System in FIN Holding Tank Um Unsuitable kx system Z S L U M s❑ U s I U M S r1 U ❑ S 15T u ❑ S Z U SOIL DESt:RIPTKM REPORT Depth Dominant Color M011185 Structure Consis Boundary Roofs - GPDM Bor[ng# H in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. 8ed Trend, 1 1 I 0 -23 1 ORY2/2 None sl _2rnsbk -- - mvf r as 2f 0- 0.6 2 23-40 1 M Nom sl 2msbk mvtl ew 2f, fro 0.5 i 0.6 Ground 3 40-61 10Y R4/6 None s o sg ml gw 2ti 1 m 0.7 I 0.9 WOW - 91.02' R 4 61 - 1 Z$ 10YR5 /4 None s & Sr. o sg ml - - 0.7 0.8 Depth to — fmiling - I factor _ —_ _ -- - - -� ....... - - - - -- -... .- - -- >12e Z 1 0 -9 IORY2/2 None 51 2msbk mvfr as 2f 0.5 0.6 2 9 -20 I0YR3 /3 -- None fsl 2msbk I m vfr ew 2f, lm_ 0 . 5 0.6 - G 3 20 -45 1 7.5YR4/6 Note ifs Imibk mv! gw if &m 0.5 y_ 0.6 99 -80' it 4 145-125 10YRS /4 None s & gr_ o sg ml - - 0.7 0.8 Depth to limiting Remarks:_... _ CS7 Name (Please Print) signatu • f Telephone No. m Jamta K. Tho mpson / y -- 715 -249 - 7767 _- ydd aC .Soil 9i0c Evaluetinns Date CST N~ Iwo 340 Paulson Lake Lane, Osceola, 54020 11/1/99 3602 10211 FEB -01 -1999 01:34 PM A.C.E. Soil & Size Eual. 715 248 7764 P.03 Plio�crfowlnat M awr. s.�a �. SOIL DESCRIPTION REPORT tt>QO pne 2 of 3 ._ Pica tD11 t tz 41lo —_ .. A.C.E. Sol a sib Ramada* Depth DWkmt Color Mt " sauc lre ttislence Boundary Rte hlorizorl In. Murtttd Qu. SY Cont. Color Tincture Sz Ste, Bad Trench 3 _ 1 04 l ORY3 /2 None Is o s g ml ae 2f, 1 m 0.7 0.8 2 7 -22 7.SYR4 /6 None lfs 1 m sbk mvfr _ es 1 f 8t m 0.5 0.6 Grouted Gro 3 22.28 1 OYR4/4 N o n e Sr. 91 2 _ mfr cw I f 0.5 0 clo i 98.768 4 28 -132 lOYRS /4 No a &, Sr. Ogg m1 _ — - 1 - 0.7 0.8 Deplh to _ Sal praft ded to verify i depth of suitable sal to eccemodale lower 80 eieir UCA bullder�plurrdxw iapor , _ -... .............. > 132" I ....:: 4 1 0 - 10 IORY3 /2 Nnne lf9 Ogg — ml - ss 2 lm 0.7 0.8 2 10 -20 7.5 14 I None lfs 1 m mvfr es 1f& m 0.5 0 .6 Ground elev 3 20 -28 IOYR4 /6� None Sr. s o sg ml cw if 0 0.8 4 28 121 i, IOY RS /4 None S& M g 0 Bg Depth to factor 6arks: 1 0 - 7.SRY None sl —: 2msbk mvfr as Mm 0.5 0.6 2 1 13 - 33 ' I OYR2 /2 None Ifs lmsbk mvfr i cw 2f, lm 0.5 0.6 Ground - — — elev 3 33.50 1OYR4 /6 None s ass ml gw if & m 0.7 0.8 95.77' R q 30 -1 19 10YR5 /4 Non 0.7 0.8 Depth io - �- ..._ - - - -•- -- - i _.. fad4r Remo": — _.......___.....___.... __... —. Ground-• .._�_... ._____. - -- � ._ _ _.,.� _..... - - --- � -� -- elsv Depth to _ IUniting factor Remarks: FE•B -01 -1999 01:34 PM R.C.E. Soil & Size Eual. 715 248 7764 P.04 r 0 , z Ih M o ■L - ■ m �Cb :.r Rod Eslinger From: Jansky, Leroy [Ijansky @commerce.state.wi.us] Sent: Saturday, October 30, 1999 6:24 AM To: 'Rod Eslinger' Subject: RE: Three season porches It should be treated the same as for a mobile home without a footing but set up on concrete block or cement/wood pilings - 15 feet. Eight feet is kind of high off the ground and I suspect we would consider a closer setback for an unenclosed support area below the enclosed living area. • - - - -- Original Message - - - -- • From: Rod Eslinger [ SMTP:Rode @CO.Saint- Croix.WI.US] • Sent: Friday, October 29, 1999 4:01 PM • To: Leroy Jansky (E -mail) • Subject: Three season porches > Hi Leroy: • What is the setback from the drain field to a three season porch with no • footings about 8 feet above the ground? If would have been a deck if the • owner didn't enclosed it. Because it is attached to the structure would • the • setback be 25 feet. • Thanks • Have a good weekend! > Rod 1 Safety and Buildings Division Vi s cons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83.05 Wis. Adm. Code P o Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. , vyv t • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for second purposes 40e. ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. �/ �(`/ C^ ,/ Q O `I State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro erty Owner Name P opert Location / �� ;� �, Sjet /4 ?,. 1 /4, S Z / T V7, N, R / f* E (oqj ) Property Owner's Mailing Address Lot Number Block Number City, State Zip Code PJlone Number Sub ivision N m r S Number -7 Ed OM5 . TYPE OF BUILDING: (check one) ❑ State Owned E] i t Nearest Road / l Public 1 or 2 Family Dwelling- No. of bedrooms E] Voiag OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo o zo / 3 J s—! 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) 1New 2 ❑ Replacement 3. ❑ Replacement of 4_ E] Reconnection of 5. ❑ Repair of an ystem ________ 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 6j Seepage Bed j 21 E] Mound 30 ❑ Specify Type 41 []Holding Tank 12 Seepage Trench {. F R 22 E] In-Ground Pressure / 42 ❑ Pit Privy 1 E] Seepage Pit 1 . `' Y. 3 43E:] Vault Privy 14 ❑ System -In -Fill 'tI'r 5df !"t IT r7 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation - � 'Z rr- fo XrFeet C?Q 7 t Feet VII. TANK Capacity in allo Total # of Prefab. Site Fiber- - INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic Exper App New Existin structed Tanks Tanks S c Tank r Holding Tank ©eX.� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum igna ure: Stamp MP /MPRSW No.: Business Phone Number: Plumber's Address Street, City_State, Zip Co � L 7 IX. COUNT Y7 DEPARTMENT USE ONLY ❑ Disapproved S Itary Permit Fee (Includes Groundwater ate Issued Issuln gen Signa ure (No Stamps) proved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) 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 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 is to be installed, II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches 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. i J� � N1 L 4-1 � 4 4 Na coo 43 ki to V) ki � a "1 �1 kjo 4 4 40 .r T + ZD tf E E Z C cti CD X (h U U �.. p to O � CA ! co "❑ U 111 1 KKK/// vvv ttt!!! v O O x co - U U cu c N N Q (b Q U �� r r E 4 S C O O O O F-� N I U -p 0 >, t� cu U U p 7 y C O> d C \ O N x 4 L i0 E cU N C a � � NOCU,c � `_ N> O a> a O _t ca lL E O = U O ' U 05 C ✓) • • • • j c 00 V. a C: Q) . ool 0 f v N r• �J V g .. I— O Z ,1. N O a .' E 3 w 8 � U CO cn cp w co v W. W • v 3 0 L + � c� r n E • • UJ `o C ; N ^ (D o U 03 m �, s O p CL Lti (D u) U ❑ ❑ i.t I LU� cc �C Q - 3 '� N g v $ cc J Page -1 of 3 Wischrain Department ofCommerce SOIL AND SITE EVALUATION Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code �``1 �' A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8' /z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refean'k direction and St. Croix cent sl scale or dimensions, north arrow d I o ..bnd to nearest road. - - Pte. n .? Parcel I.D.# APPLICANT INFORMATION /0' prin aWormatio 020- 1056 -90 -000 - -- - - Personal information you pr ovide y used 4o6 ry p ,(RAY cy Law s." 5.04 (1) (m)). Re iew � e ,( d , B � y �� Date Property Owner Property Location Miller, Sam .g Gott. Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W Property Owner's Mailing Address, . # Block # Subd. Name or CSM# Box 151 Trout Brook Road '�UNTV 9 Home Place - - - - - - j City State Z►p trade Phoner�rE %'\ ] City Village • )Town Nearest Road Hudson W 1 5446 7-1. Hudson Grant Avenue [ New Construction Use: Residen6a bedrooms 3 �_- _.lAddition to existing building I j Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate • bed, gpd/ft .8 trench, gpd /ft Absorption area required 643 bed, ft' 562 trench, 2 ci d ign loading rate •7 bed, gpd/ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) _ 9"/.25' 1 • _- ft (as referred to site plan benchmark) Additional design / site considerations Parent material Outwash s & gr. Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ZS - U ❑ S❑ U ❑ S❑ U ❑ S❑ U ❑ S M U ❑ S❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles 1 Structure GP D /ft Horizon Texture Consistence Boundary Roots Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -23 1ORY2/2 Non s l 2msbk mvfr as 2f 0.5 0.6 2 2 -4 0 10 /3 None sl 2msb mv fr c w 2f, lm 0.5 0.6 Gro 3 40 -61 � 10YR4 /6 N s o sg ml gw 2f, lm 0.7 0_8 - -- 98.02 ft 4 61 -1281 10YR5/ No s & gr. ( o s ml - - 0.7 0.8 Depth to -�- - -- I -`— !! - - -- - - -- -- - -- - - - - - -- - - -- -- limiting t -- - - -- { - - - -- �- - - factor 2` � - - - -- -- }- -- -- > Remarks: - 2 1 0 -9 1 l ORY2 /2 None - sl 2msbk mvfr as 2 f 0.5 0.6 2 I 9 -20 1 I OYR3 / 3 Non fsl 2msbk mvfr cw 2f, lm 0.5 0.6 Ground 3 20 -45 1 7.5YR4/6 None If s 1 msbk m vfr g w 1 f & m 0 5 0.6 elev f - - 99.86' ft 4 None s & gr o sg ml 0.7 0.8 1 45 -1251 10YR5/4 II -- - -- _ _ -- �- -- - -__ - - _- _ - -- - -- - -- -. i De pth to limitin factor o � >125" Remarks: -- - - -- - - - -- -- - -- -- - - - - - - -- CST Name (Please Print) Sign ture: Telephone No. James K. Thompson s' 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola WI 54020 5/7/99 3602 1020 PROPcR.TY OWNER , M - Sam - SOIL DESCRIPTION REPORT to2o Page -_2- of 3 P kPCEL I.D # . 020- 1056- 90-000 A.C.E. Soil & Site Evaluations - Horizon Depth Dominant Colorer Texture Structure nsistence Boundary Roots i GPDlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -7 10RY3/2 None is o sg ml as 2f, lm I li 0.7 0.8 2 7 -22 7.5YR4/6 None Ifs 1 m sbk mvfr cs 1 f& m! 0.5 0.6 Ground - elev 3 22 -28 10YR4 /4 None gr. sl 2msbk mfr cw if 1 0.5 0.6 98.76 ft 4 - 28- -- t21 l 10YR5 /4 None s & gr. o sg m1 - 07 0.8 Depth to limiting factor { >121" 9 Z.B�f °`" i' l o I Remarks: 1 0 -10 IORY3 /2 None Ifs o sg ml as 2f, lm j 0.7 0.8 4 -- - -- - -- - -- -- -- - - - -- - - - -- - -- - - - - 2 10 -20 7.5 YR4 /4 None ifs 1 msbk mvfr cs 1 f & m 0.5 0.6 Ground— _ - -� -- _ - - - - - -- -- �- _------- - - - - -- - - -- -- - _ - - -- - - -- - _ -- elev 3 20 -28 10YR4 /6 None gr. s o sg ml cw if 0.7 0.8 97.21' ft 4 28 -121 10YR5 /4 None s & g o sg ml - - 0.7 0.8 Depth to limiting - factor >121" Remarks: 1 0 -13 7.5RY3/2 None sl 2 mvfr as 2f &m 0.5 0. 6 2 1 -33 IOYR2 /2 None ifs lmsbk mvfr cw 2f, im 0.5 0.6 Ground elev 3 33 -50 10YR4/6 None s o sg ml gw lf& m 0.7 0.8 93.77' ft 4 50 -119 1 /4 None s & gr. o sg ml - - 0.7 0 Depth to (_ limiting - -- factor — >119 -' Remarks: -_ - I 1 Ground I 1 elev - - Depth to limiting - - - -- factor �- - Remarks: 1 0 3 of 3 •. U r s N o � � . t e J � CA �c ■ LA f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer.. "�� -i, Mailing Address Property Address - (Verification required from Planning Department for new construction) City /State s 014 tit..-a Parcel Identification Number 0 3 Ste` © 40 0 � LEGAL DESCRIPTION Property Location '/4, ' /4, Sec. , T31N -R Town of CT1J 'Subdivision Lot # . Certified Survey Map # e4 ' - S - 7 ?- -Volume Z Page # S Warranty Deed # ( 4 , Volume f 3 ( Page # 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 requiremtnts and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days of the three year expiration date. ZIA 7 S A O LICANT DATE WNER CERTIFICATION t"(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 tb . described¢bpv b virtue of a warranty deed recorded in Register of Deeds Office. �fJ ATURE CANT 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 r Lip C ,1 J VOL •1:36 PACE 11 4 Document Number WARRANTY DEED This hoed, made between. - r Robert L Rohl t* Grantor, l� and. Sam E Miller S GISfiE�t`5 -, TI a single person Grantee. CROIX CO.. WI 0*3 Witnessoth, That the said Grantor. for a valuable cor•90 e eratlon of on RKI far 400"W tv! other valuable Consideration conveys to Grantee the bebw xsa,bed real estate to in in and p�T p 6 19 QQ St. Croix County, State of Wcr a.s,n This is not homestead property. 9.30" .4 ' Together with all and singular hereddaments am appurtenances thereunto � ter M 0.,b belonging: w r d► And ' Gr ant or warrants that the title is good, indefeasible in fee sarpie and free and clear of encumbrances except Recadirio Area easements, Covenants, and restrictions cf record, Name and Return Address + R and will warrant and defend the same. Sate E. Mailer i ft Jentl5catlon Number) F0 Box 151 r i 020- 056 -90 Hudson WI 54016 w A parcel of land located in the SE 'A of the SE '. , of Section 2 I . , r29N, R 19W, Town of I Judson, St. Croix County, Wisconsin, described as follows: beginning at the SF corner of said Section 21; thence N 89'23'5 I "1k' 1319.10 feet to the monumented West line of the SE of the SE !'4 of said Section 21; thence N00 °51'33 "W 980.09 feet along said monumented West line of the SE '/4 of the SE 'h to the North line of the South 3010ths of ! the E '/2 of the SE' /. of said Set. ion 21 as caliee gut in that documentation found in Volume 838, Page 252 of the St. Croix County Register of Deeds; thence S99'371 9T 6 feet along said North line of the South 30 /80ths to the intersection of the monumented South line of the Certified Sure% Map tiled in Volume 2, Page .' 484 and the said North line of the South 30-80ths of said E ',: of the SE ' /4; thence S89'23'1 OT 31.88 feet to a found 1" iron pipe being the SW Comer of said Certified Survey Map; thence continuing S89 °23'10" 1' 660 24 .1s a feet to the East line of the SE 'h of said Section = 1. thence S00 °5 I'50T 982.41 feet to the point of beginning. containing 29.725 acres including rigi.. of wa% r =8.006 acres excluding right of %%a%). • Da this _ da of 189_ T AIoFER �, a o J Robert L Rohl F k c AUTHENTICATION ACKNOWLEDGMENT. Signature(s) STATE OF WISCONSIN '� k 1 COUNTY S1'. CROIX s Personally camg before me this day of CcT r?f the authenticated this _ day of above named Kobert L. Rohl to me known to be the person(s) who executed the foregoing V ;L signature i ons t and ackedge th. same. V� nowl l ; type or print name t , y ,,,,, e ■ type or print name v2A - TITLE MEMBER STATE B4R OF WISCONSIN tart public County. h.- v (If not. O Y pV om isslon Is_ perma�rker (if not. state expiration date authonted �§'� slats.) ; r� THIS INSTRUMENT WAS DRAFTED BY 2 'N a arsons signing In any capacity should be typed or ., Robert F. Wall MEN 14n w ow signatures • (Signatures may be authenticated acknowledged Ho are WSHd >.. necessary.) y . ; OF i . 1 LOT 4 OF • CERTIFIED SURVEY MAP PLAT OF PRAIRIE VISTA VOLUME 6, PAGE 1768. LOT 6 A W MONUMENTED WEST LINE OF THE SE1 14 OF THE SE1 /4 LOT 7 A R Soo 51'49 N 00 51'33" W 980.09 260.83 3 3 02 324.98 / 56.21 o 361.26 - ° ms o ti 947.07 v U ; a 1 00 3 ° I c u �? N 6 ;0 c 3 N � M11ZL1A m v N (J 11 �C Na 1 a /� 0 � 8 �� s S r' ' • 171 q w - 4 'A Y W CA c W `(1 W 33' 33' O im m 2y 1M ) 1 W i ds u ° C0 p tS` 1 U 1 � n 3 a c a c� Q ab A _ . o .A p 0 La CL m l 1 (�, boll ovs•30-im O � - Z9 - £q A6,IMXZ .00 S - 0 N 1Nvae. C4 " �� Z9'£LZ 3 .Ib .ZZ .d6 N g �n nD o. �' rn m °D tp 3 ro ti o a m 130 338 ,p fl'1 m 4 � w f 6 11 M .I► .M .00 ,. m mX AA 81 d � ° N Q ^ JO MX B J r .°. m v u p N T o F o O°j�o�' a � IQ � a r— 4 -� n x 3, 8 8 O 9 0 +OO 4$I$2 ° E w /� 0 9j g C R� O N O � O o� N X N N m r . O o � z 3 0 �„ u. N 00 tiw m X46 j co Op ° M.Et.IV.IOS W 2919 U1 rn .o L A m CA (� .� N o - W a o o P N 00 ( CO) t V W o 0 C. 9E'99 m ° � m CT N c0 3.Eb.I4.lo N 2 �!. w a W w cn 2 N A N A _ M. o ♦ and d� j CID w my N i� S NO ° 51'50" W 692.93 (N - 165.52 307.41 220.00 ° t �g E CORNER a - '• ,SECTION 21 8 Nw DEDICATED TO THE PUBLIC R Sol 01'43 "E > S 00 51'50" E 982.41 U.S. HW Y "12" $ EAST LINE OF THE SE 1/4 OF SECTION 21 UNPLATTED LANDS ST. CROIX COUNTY WISCONSIN ZONING OFFICE v o n e n a n ST. CROIX COUNTY GOVERNMENT CENTER +■ +, 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 December 29, 1999 First Federal Attn: Tammie 201 South 2nd Street Hudson, WI 54016 RE: Septic Inspection for Sam Miller located at 808 Grant Avenue, Homeplace, Lot 9, Town of Hudson, St. Croix County, Wisconsin Dear Tammie: A septic inspection of the above referenced property was conducted on November 2, 1999. This property is located in the SE' /4 of the SE' /4 of Section 21, T29N -R19W, Homeplace, Lot 9, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, (10 k C Kevin Grabau Zoning Technician /sm