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HomeMy WebLinkAbout030-2108-80-000 Wisionsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ` GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: X Personal information you provice may be used for secondary purposes [Privacy L w, s.15.04 (1)(m)]. 344624 Per R6Xft�iN �mMARCEL ❑ ctA� Vil la 8 H wn of: State Plan ID No.: CST BM Elev.:- 1V Insp. BM Elev.: BM Descripti n: U Parcel Tax No.: j/ 030 - 2108 -80 -000 6 TANK INFORMATION ? — /— ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j e LOV Benchmark 0 33 d Dosing b � D � All Q `�i(� l z 3 Bldg. Sewer 9a Holding 0Ht Inlet3 TANK SETBACK INFORMATION utlet TANK TO P/ L WELL BLDG. Air I nt a ke ROAD Dt ir Septic fi yD A- 't- y' NA Dt Bottom S I<P 7. Dosing � Aj r NA Header / Man. �• f og. 3 Dist. Pipe TZ . r'&P Holding Bot. System .- PUMP / SIPHON INFORMATION Final Grade 4�J� Manufacturer 6 �4 Demand 3 Model Number rQ Ll tj GPM TDH Lift Lriction �,/ System TDH'Ft Forcemain Length 1 0 0 ( 1 Dia. Z Dist. To well SOIL ABSORPTION SYSTEM Z BE EN w idth Length No. Of Trenches IT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LE Ma u A INFORMATION Type O ( .i HAM iviodei Number: System:C� (� r /i) y (QQ NIT r C DISTRIBUTION SYSTEM Header/Manifold y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 'P Dia - Length _)� Dia. &4 Spacing AM >/ � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 4 /Z /f 5 LOCATION: ST. JOSEPH 3 1 64TH STREET — BUCK HILL LOT 12 FoP Ct d ✓ •�S �d1M Z • / o / 7 L P ' !�'i� o r a e egl -o 1 5 ' eA tJG l I r ir^ -Fi V'4A y S �G'�` Q r Gua S Sfo u ►' love nw P Plan revision required? ❑ Yes fA io No Use other side for additional inform tn. z Z F7, L /,,, � -1 ( M )G SBD -6710 (R.3/97) Dat Inspecto . Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' __am R € t ®...- �...... . € € s I .�w ; ' ._� h em. { F a F f E a ( E } F E { E g 3 s i E o F a € s �....,.... P._.. e. �. ...:.... «. ..._.. «_.. mve . >�.... ..... ... >r,i .., a � _... m ,. __... ae. ,a ...., e.......d�.�.�..e�m.€ is € m 1 q N I i Y 4 3 t e d E L Aa r 3 { € � µ r I ......... ,e .. ... Am. .�..qu .. L °e s E J 3 € ams d....�..... - - - ----- e,- ...,. .., r ,....,,, & .,.y......... E i .. ..., .,..a... E f g # ¢ x 7 ems —�P 3 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Visconsin I n 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 i than 8 1/2 x 11 inches in size. J • See reverse side for instructions for completing this application State Sanitary Pe rmit Number ta y mi Personal information you provide may be used for secondary purposes / heck it �evisi6n fo previous Iicalion [Privacy Law, s. 15.04 (1) (m)]. 1 ` 9 L1 /' ! / 4 � 7 ! C r State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pro pe y Owner Name ` Property Location X1/4 N x,(1/4, S 3 T a , N, R Property Owner's Mailing Address Lot Number Block Number City, St at Zip Code Phone Number Subdi ion Nam or CSM N b 11. TYPE OF BUILDING: (check one) ❑ State Owned it Nearest Road ❑ Village Public U 1 or 2 Family Dwelling - No. of bedrooms & Town OF 'r C. �� 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 0 :30 d 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 E] Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. [pl'New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________System _____________ Tank Only______________ Existing System _'______ ExlstingSystem B) A Sanitary Permit was previously issued. Permit Number Date Issued ' V. TYPt OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12;g Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit � C��„ j 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 Required (sq. ft.) Proposed (sq. ft.� (Gals/d y /sq. ft.) (Min. /inch) EI vation Feet Feet VII. TANK Cap acit y in allo Total # of Prefab. Site Fiber INFORMATION g Gallons Tanks Manufacturer's Name Concrete con Steel glass Plastic Exper. App New Existin Tanks Tanks strutted Septic Tank or Holding Tank 66 I do 0 1 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber RO 10 ❑ ❑ ❑ 1 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plr's a Qi Plu e: (Print) mber' Ignatu . {No St p / RPRSV�o.: Business Phone Number: � 1T y ar Plumbe�� dress (S�eet, C� te, Zip o e): IX. COUNTY / DEPARTM ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) []Owner Given Initial C � Approved Surcharge Fee) Adverse Determination 1116P. 0 X. CONDITIONS OF APPROVAL PREASONS FOR DISAPPROVAL: l ao.\eil.1s1 k a 4w 4 Atgoe, � a�^-- �evi+ire �'�her �� -�-,0 �4 SBD- 6396 (R.11/97) DISTRIBUTION: Original to County, One copf To: Saf ty & dings Divi ion, Owner, Number 1 j r 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 a d 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 foss; 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. ` r NEk W S3- T29N -R19W town of St. Joseph lot #12 -Buck Hill N 1 "=40' BM.= top of 1" pvc pipe @ el. 100' Alt. BI.= top of 1" pm pipe @ el. 100.05' IV ptP « < < r 4 4 �r y An F/ N r�oo- 7 a 35 Z 7(3 c / 0 � 9 -01 -1999 3:35AM FROM GARY L STEEL 715 +246 +6200 P.1 SOIL AND SITE EVALUATION REPORT' PaEe l vf. 1 �� . end FMA1n Rela6m 1>srhor of Saretr li Bui�r�s rd with I LH R. 83.06 Wis. Adm. Code in acco , Aftch.aoinplow site plan on paper not lose than B 1/2 x 11.inches in e¢e..Pian,must, indude. but . . St. Croix not limited to vertical and horizontal reference point (SM). direction and % of slope, scale. or PAACEL I.D. # dimensioned, north arrow, and location and distance to neai road: 030- 100895 - 000 APPLICANT INFORMATION- PLEASE .PRINT ALL INFORMATION REVIENIED 8Y DATE PROPEMY OWWR: PROPERTY LOCATION Steve HeOgin GOVT. LOT NE 114 NW 1/4,S 3 T 29 AR 19 ' *(«) W PROPER'T'Y ONNER`S MAILING ADDRESS LOT N BLOCK # SUSD. NAME OR CSM # 1182 61st: St: 12 na JBW HT 1 CITY, STATE ZIP CODE PHONE NUMBER ITY (]VILLAGE DOWN NEAREST ROAD Hudson, W7. (7 - ° [N New Caclsholk n Use [ .if AeSiden6al / Number of bedroor- S 4 [ a Addition to existing building [) i�eplaoemertt [ ..] PLOic of aor"I'deA des be, Cade derives aaigr flow . 600 gpd Recommended design b0 mg rate . • 7 bed, g _$_ tr Xh..9PdAl�. Ab caption area required 8 bed, }I2 750 trench, fr Maximum desir badirig rate .7 bed, gpdM T 1r8*A, gpdM Recommended 1nMratim satiate e* ation(s) 95 . i R (as reft3rred b site plan benohrrrark) Addlional-design t sine mnsideWons ria Parent material r>ntw _- _ -�.- -- ._ -..,— ,.... Fiood plain elevation, NapplitaaW T _. na ft S - Suitable for system CONVeunMal WU14D W.GWISID PRESSURE I AT.GRA srsn m IN FILL HOLDW T11 U� Unsuitable for m fl ste s O u JE s O U XIS c'] u Ian s ©U Ili s o u ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color manias Texture Structure Corasisoenc�e 6otrd®y Roots GPDPft in. Munsell Ou. Sz. Cant Color Gr. Sz. Sh. Bed Tierich = 2 10 r3 . none 1 2.c . mfr cs . 2f 2 12-40 1 Y / _ 1 10yr4/4 1 0� none ail ImbJK of I g'v i f .2 .3 Gnwrd 3 4d.vjW 7.5yr4/4 nine Co B Gag mvfr na na .7 .8 99.5ft, _- Depth rA limldng /0 Remarks: Boring # 1 0 10 10yr3 /3 none.. 1 2csbk .,mfr ce . 2f. .5' .6 2 2 10 -34 10yr4 /4 mane sil lcsbk , ulfi gw 1f .2 .3 3 3442 10yr5 /4 none ail M na. 9v 1f nP .2' Ground 9 K 4 4 7.5yr4/6 name co s Osg mvfr na na .7 .8 Depth to limiting Remarks:: CST Name:--Please Ptint Cr L. Steel , phone. 71.5446-6200 caddies: 1554 200th: ve; New mond WY 54017 9 -01 -1999 3 -3GAM FROM GARY L STEEL 715 +246 +6200 P.3 PgapEmoavt - Steve Henn SOIL DESCRIPTION REPORT Page 2 of 3 .PARM I.D. P ' 0j0 -95 -000 a . goring # Horizon Depth Dominant Color Mottles Texture structure Consmum Via ► Roots GPOlR in, Muns#il clu. St. Cant Color Or. Sz. Sh_ Bed M wO 1 0-14 .10yr3 /3 node 1 Z 1 mfr gtr 2f _ ML .2 3 2 14-48. 10y-r4/4 none Sil M na grr if np .2. app 3 48 '7.5yr4/6 none co S 089 tavf'r na m .7 .8 99. 1 1 D2pM to r limiting Factor + l° Remarks: Boring # 1 0 - 15 10yr3/3 none 1 lcsbk mfr' gv 2f . 2 ; .3 4 2 1544 10yr4 /4 none oil 1CS tc mfr 9W It .2 .3 3 44 7.5 yr4 /6 none co s Ong mvfr ria na .7 i .8 . JW Ground elev. $ - 3 1 9LQn i Depth to Gmirxg tau +84v' Remaitcs: - Boring # 1 0-13 10yr3 /3 none 1 2csbk mfr. yw 2f .5 .6 5 2 13-41 10yr4/4 none oil lcsbk mfr gw if .2 .3 3 41- 7.5yr4/6 none co s Osg mvfr na na .7 i .8 Gra„ d �81 --- 99.1 t< — Depth Iwo - �m�n� WW +e4. Remarks: Boring P i Ground L., i afar. , ft Depth >A Gmidng 9 -01 -1999 3 :35AM FROM GARY L STEEL 715 +246 +6200 P_2 r � w r Y STEEL'S SOIL SERVICE Gary L Screed 1 200th Ave_ CSTM2298 Steve Henning New Richmond, W1 54017 MPRSW -3254 NEk S3-T29N -R19w •(715) 246 -6200 town of St. Joseph lot #12 -Buell Hill 1.� >�I.= top of 1" pv�c pipe �• ei_ 100' This soil evaluation was conducted to Alt. s�[.� top of 1" pvo pipe 9 el. 100.05' satisfy a zoning requirement, it may or may rmot be .suitable for your use. The lcobation of the test May or may not be an Abom as permanent lot lines had not � been established at the time of testing. .f 33 4Z I Ap PA D � �1 + Gary L., Steel 7- 10--98 Sep -01 -99 10:30A P_02 L: ROSS SECTION AND SPECIFICATIONS 4" Cl VENT PIP " E 2? MiN. ABOVE GRADE E 2S' FROM DOOR, WINDOW OR WEATHER PROOF FRESH AIR INTAKE JUNCTION BOX APPROVED WITm CONDUIT MANHOLE l FINISHED GRADE 4' CI RISER W/ PADLO( 6" MIN. WARNING 1 ABOVE G ADE v" MIt 18" IN. 6" MAX. INLET WATER TIGHT SEALS GAS- 4 11 T TIGHT. ; CI PIPE BAFFLE A SEAL APPROVED 3' ONTO �- LM JOINTS W/ SOLID B ' 0 N PIPE 3' 0 SOIL C ' . SOLID SO! PUMP OFF ELtV . FT, OFF •• RISER D PERMITTtD IF TANK MANUFACTU) 3" APPROVED BEDDING UNDER TANK HAS APPRO' SPECIFICATIONS CONCRETE PAD SEPTIC / DOSE - - - - ....- TANK MANUFACTURER: NUMBER DOSES PER DAY: 'TANK S2Zrs; SEPTIC GAL. DOSE VOLUME INCLUDING DOSE GAL, FLOWBACK: L ALARM MANUFACTURER: MODEL NUMBER: _ � Z Z4 /I/ CAPACITIES: A : 2(( &NCHES SWITCH TYPE: - - _. 3 f'UMP MANUFACTURER: ? INCHES = MODEL NUMBER : C = o gt S dINCHES = �ya SWITCH TYPE: — D = = oY � KEOUIRED DISCHARGE RATE � INCHES —I o z PUMP E ALARM WIRING AS PER ILHR 16.23 BETWEEN VERTICAL DIFFERENCE PUMP OFF AND DISTRIBUTION PIPE + MINIMUM NETWORK SUPPLY PRESSURE - + 1��_ FEET FORCEMAIN X FT/ 100 FT. FRICTION FEET FACTOR FEET TOTAL DYNAMIC HEAD ' 7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH L FEET WIDTH ; DIAMETER LIQUID DEPTH 10d L IGNED: - ZL�2 LICENSE NUMBER: Goulds Submersible Effluent Pump 3 871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability_ • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Motor: Available for automatic and •Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical RP points. • Water transfer 230 V, 15 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, , built in overload ad witit h automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design /4 maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Sp Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1 1 /2 " NPT_ plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, SJTW with plastic enclosed design for g improved performance. end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 •Capable of running y dry without damage to 9 30 fscP►a components. Pump: EP05 8 1 ` —z.sFr • Solids handling capability: c 25 3 /4 " maximum. w • Capacities: up to 60 GPM. U 6 20 • Total heads: up to 31 feet. 5 • Discharge size: 1'/z" NPT. i 5 • Mechanical seal: carbon- 0 1 s rotary/ceramic - stationary, _ 4 BUNA - N elastomers. o EP05 • Temperature: 3 10 104 °F (40 °C) continuous 7 ePO4 140 °F (60JC) intermittent. 5 1 ' 0 �0 10 20 30 40 50 GPM r[ 0 2 4 6 B 10 1 m I CAPACITY (F) 1995 Goulds Pumps Effective May, 1995 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue isconsin I n 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. a, • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary pur os t revii rev'stOn sionj+� ❑ C heck i f to previo s application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. 'APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION P operty Owner Nam Property Location (� (,� %W4 U)1 i 4, S T 2 , N, R j q E (or Pto etty wner's Mailing Address Lot Numbel Block Number M Cit , State Zi de Phon Number. Subdivision Name or CS Nu ber Ito 1 >� II. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road Village G *T 14 E Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Ill. BUILDINGUSE: (If building type is public, check all that apply) Parcel Tax Number(s) o30 _.a]0 • �1•t ��- 1 ❑ Apartment/ Condo 2 E] Assembly Hall 6 E] 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System _____________ Tank Only______________ Existing System ________ ExlstingSystem 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 Trencha'Ha (',U+Qu WP- 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit SJ.OLQUjUVIJ v 43 E] Vault Privy 14 E] System-In-Fill �� a Ll 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 Re ulred (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. /inch) Elev tion o() 150 2, N ' 10 Feet 49 Feet C VII. TANK. Ca ss y INFORMATION In gallons Total # of Manufacturer's Name Prefab. Con- Fiber- Plastic Exper. Gallons Tanks Concrete Steel g lass App New Exlstln strutted Tanks Tanks Septic Tank or Holding Tank �2.P 0 •— ❑ ❑ E] 1:1 0 Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum r' Signat re' P PRSW No.: Business Phone Number: r a a 35 -7 ►5�ato 8- (a gq Plumber's Ad ess (St �tState,Zip ree ode): UAA1 -1o" I r4 iii IX. COUNTY / DEPARTMENT USE ONLY 9 yvU ❑Disapproved knitary Permit Fee (Includes Groundwater D at ssue Issuing nt Signature (No Stamps) 1p4proved ❑ Owner Given Initial LTD Surcharge Fee) �O fq7 Adverse Determination 1 1 xW X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber r 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 l 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 Buildirigs Division, 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: L 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; friction4oss; 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. 'a'riscoe,3Ik Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 R"dEwr avid Human Relations DivisionofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030 - 1008 -95 -000 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R VID,BY 4ATE�� 7 (2-t he-) OWNER: PROPERTY LOCATION Steve Henning GOVT. LOT NE 1/4 NW 1 /4,S 3 T 29 , N,R 19 R(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 1182 61st. St. 12 na Buck HI11 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Hudson WI. 54016 (71J 549 -6094 " [x] New Construction Use [ Residential / Number of bedrooms 4 [ ] Addition to existing building I ] Replacement ( ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft trench, gpd /ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.10 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem RI S❑ U E7 S❑ U �7 S❑ U RI S ❑ U ® S El U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10yr3 /3 none 1 2csbk mfr cs 2f .5 .6 1 2 12 -40 10yr4 /4 none sil lcsbk mfi gw if .2 .3 Ground 3 40 -88 7.5yr4/4 none co s Osg mvfr na na .7 .8 elev. 99.5 ft. Depth to limiting factor +88" Remarks: Boring # 1 0 -10 10yr3 /3 none 1 2csbk mfr cs 2f .5 .6 €< 2 2 10 -34 10yr4 /4 none sit lcsbk mfi gw if .2 ':.3 3 34 -42 10yr5 /4 none sil M na. r np 1.2 ` Ground 4 42 -88 7.5yr4/6 none co s Osg fr. n� na ,y;:,7 .8 9 61e� ft Depth to limiting factor y p Remarks: '(�r CST Name: -- Please Print Gary L. Steel Phone: 715-246-6200 G Address: 1554 200th. Ave., New i mond WI 54017 Signature: Date: 7 -10 -98 CST Number: m02298 PROPERTY OWNER Steve Henning SOIL DESCRIPTION REPORT Page? ,,pf 3 PARCEL I.D. # 030 - 1008 -95 -000 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 4G: 1 0 -14 10yr3 /3 none 1 2cp1 mfr gw 2f np .2 « . 3 2 14 -48 10yr4 /4 none sil M na gw if np .2 Ground 3 48- 4 7.5yr4/6 none co s Osg mvfr na na .7 .8 elev. 99. l ft. Depth to limiting g factor +84 i Remarks: Boring # 1 0 -15 10yr3 /3 none 1 lcsbk mfr gw 2f 1.2 .3 4 2 15 -44 l 0yr4 /4 none sil l csbk mfr gw 1f .2 :.3 3 44-84 7.5 yr4 /6 none co s Osg mvfr na na .7 .8 Ground elev. 9 9.0 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -13 10yr3 /3 none 1 2csbk mfr gw 2f .5 .6 5 2 13 -41 10yr4 /4 none sil lcsbk mfr 9w if .2 �.3 3 41 -84 7.5yr4/6 none co s Osg mvfr na na .7 .8 Ground elev. 9 9.1 ft. Depth to limiting factor +84" Remarks: Boring # ................. Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) t < 1 s - STEEUS SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Steve Henning New Richmond, WI 54017 MPRSW -3254 NE4Nw4 S3- T29N -R19W (715) 246 -6200 town of St. Joseph lot #12 -Buck Hill N 1 " =40' This soil evaluation was conducted to BM. top of 1" pvc pipe C el. 100' Alt. BM. top of I" pvc pipe @ el. 100.05' satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines had not /7/ been established at the time of testing. 1' ( 3,2 t +1t 4z i Q � p, L ( t i Gary L. Steel 7 -10 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer , „ ra, r , ce _ / It��.., , G / ,,, Mailing Address _�-, �5 c?� �-.s-Ot o a Property Address L° (Verification requited from Planning Department for new construction) City/State ems- Parcel Identification Number 3- a /0 a 60 0 o LEGAL DESCRIPTION 3 Property Location _U* ;, j _ ��, Ste, Jfit �?� R-O—W, Town of si Z05 Subdivision Lot # L 1__ Certified Survey Map # Volume . Page # Warranty # Volume Page # Spec house ❑ yes Lot lines identifiable Z 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 wastewaterdisposal 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. Uwe, 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF AP CA� - ffi / y / — St ' r DATE OANER CERTMCATInN 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SrGNATURE OF APPLI ANr ' -d ,Y/ P? DATE * * * * ** Any information that is mis- represented may suit in the sanitary permit being revoked b the Zoni D y g 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 .1447PAC:173 6OS12o STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS neurngnt Numher WARRANTY FIRM ST. CROIX CO., WI This Deed, made between Steven W. Hennins and Norma J. RECEIVED FOR RECORD Henning husband and wife, 08 -06 -1999 9:30 AM WARRANTY DEED Grantor, conveys and EXEMPT # CERT COPY FEE: warrants to Marcel D. HoaQlan , Jr., and Patricia J. Hoa2lan , husband COPY FEE: and wife, TRANSFER FEE: 110.70 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address EAGLE VALLEY BANK, N.A. 1301 Coulee Rd Unit 2 Hudson, WI 54016 - mod Parcel Identification Number (PIN) This is not homestead property. Lot 12, Plat of Buck Hill in the Town of St. Joseph, St. Croix County, Wisconsin. Exceptions to. warranties: Easements, restrictions and rights -of -way of record, if any Dated this 5th day of August: 1999 * * Steven W. Henning * * Norma J. Hennin AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) �} ) ss. authenticated this _ day of C§+' o >e County ) I nil Personally came before me this 6111 day * of 3trq, 1999, the above named Steven W. Henning and Norma J. Henning, husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN to me (If not, known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Y-) Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is p ermanent. (If not, state expiration date: necessary.) I �� VDU 1 , .) MARLENE K. LINN Notary Public —State of Wisc My Commission Expires ?5 ' 1 " *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 • 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800.855 -2021 �• ° . 0 N l M t li LO L� N Ni LLI;m t LAR OD Qi •�� `\ ��` Z 1' �• ir 1. tz DO Z I` J I: LLI n•• M y Q iA �� J •� `' Cif M I C4. �•.: • x `00 � , , �. � �'. ' a N 3HI' J ' ff VA J F ' �•. N 00