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HomeMy WebLinkAbout030-2106-10-000 c 3 m 0 CD V a at c T CD ID cn z - z o r cn rn o 0 g 0 O v O +� d ^' fv W �C • O Co CD Cn N CD to V N O` CO N N c 0 to CD co -ft bD 0) N N C1 fD D rJ. O O -� 0 O 7 CD �I C O R O N O �. O OO K . C II '�, O r�7 z D a CD 0 N a W Ln o -- OD p W O co N 3 0 0 gym. N C �* CO CO v O i W CD o o N o c �+ co to $ rr a CD 000`!' a cn o o c Ca Co Cl) 1 < m N a Q 'c C c '" m O O CD I CD N rn co °' ' CD m A CD tv O N) CD z 0. N z z c O 0 To b CD p • � N � N �f W CD (7 a fD z CD N co -1 N O N 0 A Z A O M ._. 0 a 'p z O v ,(y p. 0 Cn -1 Cn o r z o 3 m N z _ W f I I I a 1 p � I m -n o 4 CD 0 I I ti I o I A ti 0 0 ti. O � CD v, 0 q CD O a 0 CL ti Wisconsin Department of Commerce IL AND SITE EVALUATION 1 ,DivKft of ? Safety and Buildings Page of Bureau of Integrated Services �,,i dc�ld ith S. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not I iFi h 8 1/ 4 �, in slze.:� n must County include, but not limited to: vertical and h n -tat ref (BM), and S percent slope, scale or dimensions, no 'arrow, and location and distar earest road. Parcel I.D. # U 1 � 199$ i APPLICANT INFORMATION - le>ge prin>t;iff rma>ti Reviewed by Date COUN Personal information you provide may be used fA .sdcOpdary � t r 1 Im .04 (1) (m)). Property Owner ��\` r sr � _ \ Property Location O r a ✓� t!itI c. -Ri Govt. Lot S Q f 1/4 Aj EJ/4,S `0 TP/3,bN /9370 E (or) Property Owners Mailing Address Lot # I Block=Zubd. ame or CSM# C- �'i... Le I , ems City State Zip Code Phone Number ❑ City ❑Village Town Nearest R cQ So n I Lif 1 ,5 /6 S ' s a r YJr New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 6 U gpd Recommended design loading rate -' - —bed, gpd* _ trench, gpdv Absorption area required 49-5 bed, ft2 0 trench, ft Maximum design loading rate _ bed, gpd/ft O trench, gpd/ft Recommended infiltration surface elevation(s) SSG • 7 U ft (as referred to site plan benchmark) Additional design /site considerations _ S � t< �o b-¢ r;'+ 4.0 vv� «: w k�, ;� ti r- lie s J� ¢►-Jc,r' o� Parent material L � �c[Lc `rc 1 c v-� w . 54 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 51 S❑ U W S O U 11 S❑ U [�s ❑ U ❑ s [5d U ❑ s ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD Texture Consistence Boundary Roots U in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. VT /V j0 3 4� C S Ground 5"( t ^-1 m V--t'. l -s elev. y Zo ft. y 6- /0 Y 16 �-- r>z o s ,,n 1 C Depth to limiting factor j20 in. Remarks: Boring # 1 a- �l lQ r3lz St Y OvCr c 5 c 1 �5l 41 a X. C �� y' Ground �-y �— �} yr! l C S elev. Depth to limiting factor /3a in. Remarks: CST Name (Please Print) Signa re Telephone No. a vr- c er 7-7'O o Address Date CST Number I Ilan ems sG � �� w� 3 s� 6 -/7 9 6 PROPERTY OWNER ��� w e� SOIL DESCRIPTION REPORT Pa a of , PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench a Z s.' fi a C a Ground _( /U ��/� �' < , elev. i Depth to limiting factor IM—in. Remarks: Boring # 3, G - AQ st r �lZ vi le rY/ [- S ksq (5 P Ground yZ 1/ J S - vyi C 17 + elev. Q Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n Bed , Trench Boring # 0 l 31Z S lwta� NICr` 2 1 & - Z5 - Le4 rsl 5, G / S�z / 44 'L s I C 5 Ground S elev. Q 0 ft . Depth to limiting �� fact ' Remarks: Boring # Ground elev. ft. , Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) �a .) e3�3 Zo 7c f s'3 3c sW �/? O /1 Z0. Cc/ e l'eo. 100, c' !? a ,'� /U " k�/c��er- S G.7 �!( C Iwq 8 Vo 3� 13S m r I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT ST CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344675 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: ST. JOSEPH CST BM Elev.:. Insp. BM BM Description: Parcel Tax No.: TANK INFORMATION f- Z,?- ff ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic U O Benchmark 0 l D Z o o 13 AA /0, 5' kod n Bldg. Sewer Q �S /U �- 3 g t Ht Inlet Q -0& 6(..� TANK SETBACK INFORMATION t Ht Outlet A TANK TO P/ L WELL BLDG. Ai nttoke ROAD D t Septic 7 UDl Zr) r Zp ' NA r Dosing NA Header / Man. , G 1 61,11 Aeration NA Dist. Pipe 1\ ' Job. 41 to rz f. w 6 . Ho g Bot. System �; T lay /S 160. PUMP/ SIPHON INFORMATION Final Grade nufacturer e d 1 57 2 v /O5 S� Model Num GP ZS' G io s: TDH Lrictio S ystem TDH t Z� 04 6 Forcemain Length Dia. w SOIL ABSORPTION SYSTEM �� „ BED /;r RENCA Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME ( d o r DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA ING Manuf turer: SETBACK i r INFORMATION Type Of AM Model Number: System: J 7 �p /I/i — — DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake I U `� , Length �� Dia. / r Length f Dia. VA Spacing � NA- AI 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.) ST. JOSEPH 6.29.19.885,SW,NE 358 117th Avenue — Evergreen Ridge Lot 1 0 -�6 - ZU e lo �� 0 w t" Gl 41AStnt jN 04 `f.•�.� `fr S (uCr� j�,rf�0 Plan revision reclu`ir cl? ❑ Yes No Use other side for additional inform tion. E - t z 01 1 G � SBD -6710 (R.3/97) Dat Inspecto s Signature Cert. No x `- Safety and Buildings Division Vi scons i n SANITARY PERMIT 201 W. Washington Avenue I n O Box 7302 Department of Commerce n accord with ILHR 835 ; . Adm. Cogle Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the I stem, on ess my than 8112 x 11 inches in size. p • See reverse side for instructions for completing this app i 0ion Sanitary Pe mi Number Personal information you provide may be used for seconda purposes [ heck if revi on o previous application [Privacy Law, s. 15.04 (1) (m)]. �l� -�'ti � ate Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL I Pr rt Owner Nam a tion g q # a o 1 /a, S (P T N, R� Property Owner's MaiUpg Address Lot Number Block Number it , State Zip o Phone Number Subdivision Name or CSM Numb I l© 115 1. TYPE F I I G: (check one) State Owned It y earest Road vil Public 1 or 2 Family Dwelling - No. of bedrooms 3 & Town OF cs III BUILDING USE (If building type is public, check all that apply)fj Parcel Tax Number(s) t0- 1 ❑ Apartment/ Condo 1 030 b !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 ❑ 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 E] Reconnection of 5_ E] Repair of an ____System System Tank Only System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 C] Mound 30 E] Specify Type 41 ❑ Holding Tank 12 Seepage Trench o)— raC' 1 "bI14112 ❑ In-Ground Pressure 42 [] Pit Privy 13 E] Seepage Pit -X/ X � ) . AD a 43 E] Vault Privy 14 E] System-In-Fill ;� 15_4_ .— • VI. ABSORPTION SYSTEM INFORMATION 2Z 1. Gallons Per Day 2. Absorp. Area 3. Absorp. rea 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 - 7 ` Lo 9q : U 0 Feet Q Feet VII. TANK i Capacit Total # of !Prefab. Site Fiber- Ex per INFORMATION gal Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic A p p New Existin struc Tanks Tanks e t,Nra ""MiTnr lt)C6 I 600 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I I ❑ I ❑ I ❑ I ❑ I ❑ I ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins llation of the nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum Sign ur : ( P Business Phone Number: d d o1 7 ° tea - (09 Plumber's Ad ess (Stree4tity, Zacits Zip Code) ( Syp� IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Is ent Signature (No Stamps) proved ❑Owner Given Initial `—� urcharge Fee) Adverse Determination J /6b g r / � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber Richard LaCasse SW-.NE- S6- T29N -R19W town of St. Joseph : lot #1- Evergreen Ridge N 1 =40' BM.= nail in tree C el. 100.00 Alt. BM.= nail in tree @ el. 108.50' �y d U /0") N 212. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM k Owner/Buyer �.-�', S 2. {a�� 64 Mailing Address ' "C-C . 14 ¢C,AP66-2 i2 C] A/iJ Property Address 3J�8 f 7 ` 'q lf� (Verification required from Planning Department for new construction) —§,�� City/State J� (.J� Parcel Identification Number 0 1 a LEGAL DESCRIPTION Property Location ;JM 1 / 4, A4� 1 /4, Sec. (P T -R4q - W, Town of :5 4 0 A . Subdivision Qj Lot # l Certified Survey Map # Volume 8 , Page # at i Warranty Deed # SP, 7 3 62 . Volume 4 4 13S£� , Page # Spec house ❑ yes W-do Lot lines identifiable ff`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 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 ye ir expiry on date. ?/L GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of perty de cribe Bove, b virtue of a warranty deed recorded in Register of Deeds Office. SIGNA PLICANT - 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 STATE BAR OF WISCONSIN FORM I -- 1982 5873IG WARRANTY DEED ' ' " DOC UMENT NO a t 3 5, S PALE ?13 This Deed n le FLORIAN A. WECKWEK'm ; W�:Q - "PTII, husband and wife t T W 1998 1 Uid _ LoCASSE. married perjoil -S E p 9 0 Witnesse nut the ald Grantor, for avaluable con5iL!eiutitvL-------- S I 'H�S SPACE RESERVED FC,1 REl,,ORPING, nATA conveys to Grantee the iollowi- des, reji e s t ate n ,,) --- _ Croix County, State of Wisconsin. r,AME AND RFTi-RN ADDRESS EAGLE VALLEY BANK, N.A. 1301 Coulee Rd., Unit 2 Hudson, WI 54016 030-1021-90 PARCEL - 5E1W,FiCATiON N'-'MUER Lot I, Plat of FAre rl --en Ridge in the To�,m of St -c ph Croix COun t v, i4i Scull- in. TRAM,FER FEE i not horr-stead propt•rty Is) lb 110t; logether with .ill and singular the h,!r,:d and appurt�njilces tile-e- id J, oriati_A. !Nuckwerth ind 'laxine 1- warrant, that the uric is good, indefeasible in Tee and free and !,%ir 0 and wili warrant and defend the ,ante Dattd this day of FLOFT-NIN A. WF(XWERTH (SEAL) � SFAL) _ MUMNE L. WECKWERTH AUTHENTICATION AC KNOWI. E 06 %1 E N r Signature(s) State of Wisconsin, C ro ix Co.ntv henucat d Lh S 1j% lit 19-- before "ne dhis 'fly oI Sepcember the ib,we namicd r t. 1i -�ino L. �-"uckwcr --and-Ma IIILE ME,ABER STALL- OF tNISCONMN (if [lot, authorized by §700 0( �Vi, Stats vvl�o exck:11i'd [tic -orq4o!114 It ni and actin L 4 THIS INSTRUMENT WAS DRAFTED BY Att-'rney B,-,irry ( Ltindet-!Ll MUDGE, PORTER, LUNI)EF SEG!'IN, SX. Si.r Tarr, may hr auahe or acknoc%6 �)oth are 110t jx•1m..1,cnt -;.vc el, r, I 1 11 N k )I 1A 1*,( ON11', I - 1082 " VOL. - - -- PG - - - - - -- I ---------- NORTH LINE OF THE 5W1/4 OF 1Ht NEt /4 ------------------------------- - - - - -- - "W 424 .79' ' S89'S3'18'iW 873. 8' )'38" S88 ' 38 ' 50' _ICIL - - -- -------- - - - - -- 255.30' — X I ' -' _ 51.7 2' I 373.07' 16.50' Lb� I I : I too' 3.144 ACRES c 136.950 SQ. FT. ; D `° I a P �� "id r7 I I r o I I \\ 1 z �� Z I I \ I � � ' I N 89'48' 48" H.W.L. 925.0 i C6 S 89'48 48 W - PROPOSED STRE ET - -.-to &Q_ � . -- I I 15.09' 0 _ i . / I I U-) ao C I Iui a I M N ....r.... .. ....... i r- I I .. IW�� 7 w lI') 100 I iv ' 3.019 ACRES H.W.L. = 925.0 •- lO W 131,489 SQ. FT. o � STORM, WATER ( 131.3 I 00 o RETENSION AREA C I V) Fq ` I co I ° N 89'53'16" E N 845.75'` 471.89' o9�5 °D 373.86' v� 315.75' 265.00 I w N 89'53'16" E 845.75' z I r I o 8 GARAGE N 3;617 ACRES . 9 I I 157,550 SQ. FT. • ao a0 I � h h pf I HOUSE 3.029 ACRES 3 3 3 1 ( e(. .. .. •. r1 f i � Wiscon * Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor'and Human Relations Division of Safety & 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- 2106 -10 -000 APPLICANT INFORMATION - PLEAS MT A(L!f?/I MATION VIEWE BY DATE PROPERTY OWNER: d >� . PROPERTY LOCATION Richard LaCasse �~ .0 ltl- GOVT. LOT SW 1/4 NE 1/4,S6 T29 ,N,R 19 3E (or)W PR OWNER':S MAILING ADDRW LOT # BLOCK # SUBD. NAME OR CSM # 521McCutcheon Rd. --- r> r i In - 1 na Evergreen Ridge CITY STATE IP.GODE ' kip N _, [ ❑VILLAGE ®TOWN NEAREST ROAD Aidson, WI. 54016 h k X1540 St. Jose h McKinley Dr. Pc] New Construction Use ( R ; O@ptl�l / Number of 3 [ ] Addition to existing building (] Replacement [ ] Public mmerci I i i Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft2 •6 trench, gpd /ft Absorption area required 9 00 bed, ft 750 trench, ft Maximum design loading rate .5 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 100.60 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 4.00' below grade Parent material outwash 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 fors stem L�# S ❑ U [3 S ❑ U C3 S El 1 U CX ❑ U KI S El El ME U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure GPD /ft Consistence Boundary Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n Roots Bed Trerxh 1 0 -15 10yr4 /3 none 1 2msbk DS gw 2c .5 .6 2 15 -35 7.5yr4/4 none scl 2csbk dsh gw 2m .4 .5 Ground 3 35 -65 7.5r4/6 none is Osg mvfr gw if .7 .8 10 4 65 -12 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to limiting factor 4a (I' + " Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk ds gw 2c .5 .6 2 > 2 12 -44 10yr4/4 none sicl 2msf)k dsh yl1 2m .4 .5 3 4 -120 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. I 1 04.6 ft. Depth to limiting factor +120 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th/,Ave., New-Richlond, WI 54017 Signature: Date: 7 -23 -99 CST Number: m02298 PROPERTY OWNER Richard laCasse SOIL DESCRIPTION REPORT Page?? of3 PARCEL I.D. # 030 - 2106 -10 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends « 1 0 -12 10yr4/3 none 1 2msbk ds cs 2c .5 .6 3 2 12 -47 10yr4 /4 none sicl 2msbk dsh gw 2m .4 .5 Ground 3 47 -72 7.5yr4/4 none sl 2msbk dsh gw 2f .5 .6 elev. 1 4 72-118 7.5yr4/6 none co s Osg d1 na na .7 1 8 Depth to limiting factor ilo0 +118 Remarks: Boring # 1 0 -12 10yr4 /3 none 1 2msbk ds cs 2c .5 .6 4 2 12 -30 10yr4 /4 none sicl 2msbk dsh gw 2m .4 .5 4 30 -58 7.5yr4/4 none sl 2msbk dsh yw if .5 .6 Ground elev. 5 58 -11 7.5ry4/6 none ms Osg mvfr na na .7 .8 107. 3t. — Depth to — limiting factor +11 Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2mwbk ds cs 2c .5 .6 5 2 12 -40 10ry4 /4 none sicl 2msbk dsh g-w 2m .4 .5 3 40 -11 7.5yr4/6 none ms Osg mvfr na na .7 .8 Ground elev. 10 ft. Depth to limiting factor +110 Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard LaCasse 1554 200th Ave. CSTM2298 SMINE4 S6- T29N -R19w New Richmond, WI 54017 MPRSW -3254 town of St. Joseph (715) 246 -6200 lot #1- Evergreen Ridge N 1 =40' BM.= nail in tree C el. 100.00' n Alt. BM.= nail in tree C el. 108.50 N 212 Gary L. Steel 7 -23 -99