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HomeMy WebLinkAbout032-2109-30-000 . ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT a ~ — Owner e ► H Property Address City /State 4A cm I ZQ y >� Legal Description: Lot _.-I Block — Subdivision/CSM # CL -• - = OO _ PIN # / S ec . N R W Town of tN1, i4 �. i4, s 2, .�Q 1� ��m er� � SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / from: House Well P2 7 Z S Pump manufacturer IS , Model m 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: lnQOe7 Width Length Number of Trenches Setback from: House ts0 Well P/L 45 Vent to fresh air intake 7 M ELEVATIONS Description of benchmark Elevation Description of alternate benchmark P uy6- j� d A-4-wAl Elevation x`7 Building Sewer / ST/HT Inlet /l d� a ST Outlet PC Inlet 9 7 F PC Bottom Header/Manifold 39 Top of ST/PC Manhole Cover �aa� Distribution Lines ( ) 10 ( ) ( ) Bottom of System () 9 q- 7 () ( ) Final Grade O 7 O ( ) Date of installation / /7/ Permit umber 3�� / �3 State plan number o? d Plumber's signature License number Date L lao Inspector �ohr1 Complete plot plan ur i NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. Z,L 1 PLA IEW W "1 , k INDICATE NORTH ARROW I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338973 Permi Hol __dd er's Name: 11 City El Village Town of: State Plan ID No.: M.LLER, AARON & STACY SOMERSET CST BM Elev.; Insp. BM Elev.: BM De cription: Parcel Tax No.: 00 o0 032 - 2109 -30 -000 TANK INFORMATION - } - ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n 0 a Benchmark Dosing + (r. Z4 ration Bldg. Sewer Q 3,0 y2- � Ing S Ht Inlet TANK SETBACK INFORMATION V/ Ht Outlet p Ve TANK TO P/ L WELL BLDG. Air ir i ntake ROAD Dt Inlet A Septic -4- N L 1 NA Dt Bottom 1b, Dosing / `r Z I ) / 5p NA Header / Man. ion Dist. Pipe L 6 V Hol Bot. System * r, L Jf PUMP/ SIPHON INFORMATION \jd Final Grade Manufacturer 5 4,-P Demand 5 , Z 1 Z2-. Z Model Number ME tj LGPM TDH Lift 1 Friction �Z Syeterr� < TDH Ft -4v "' Forcemain Length Z1 Dia. z u Dist. To well r JA- SOIL ABSORPTION SYSTEM BENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' q f 6L DIMEN 1 SYSTEM TO P/ L I BLDG WELL LAKE / STREA CHI anufacturer: SETBACK C INFORMATION Type O el Number: System: `�'�(s y Js(� /9 OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) N x Hole Size x Hole Spacing Vent To Air Intake Length Dia. f( Length - 1r Dia. Spacing �_. r (� f, >� U� 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 E] Yes El No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 5.30.19.1021,NW,NE 1 82 46TH STREET WIt 1 ` 31,1 y '�l sPttXr ? / r e7 �dti�l' Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Da a Inspe s Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I } } 3 E 3 € , r a. � s d � # , e e a 3 # e q S 2 3 r 9 , e c n f € m { } E # f t P t e 3 d v �mm 8 # .P, , E c i # # g 1 :f ,..,�, e .a— ,..'. . .,°....� ...� ..... ..� s, .....t.,, E , s ; i d } a r e � t } rvm r , t s, R Safety and Buildings Division 14 PERMIT APPLICATION 2 01 W. Washington Avenue n 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 8112 x 11 inches in size. 5 C (gQ • See reverse side for instructions for completing this application State Sanitary Permit er Per rm mit Number Personal information you provide may be used for secondary purposes ❑Check if revision io7 ap ation (Privacy Law, s. 15.04 (1) (m)]. State Plan I. 4 Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATIONo Prop Owner Name Property ocation e y N LDN 4- 5+AC Y /0/6cm AJ V 14 �=414, S S T 30, N, R/ E (orxg� Property Owner I , Maili g Address Lot Number Block Number N City, 5 e Zip Cod Phone Number Subdivision Name or CSM Number FIF II. TYPE F BUILDING: (check one) ❑ State Owned " It Nearest Ro d 14 Vilie Cj Public or 2 Family Dwelling - No. of bedrooms 3 ❑ Town 1 OF ft Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 03 '7 — oq '— p-- o o O 1 ❑ Apartment/ Condo _ S. �O. L 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. ❑ Reconnection of 5_ ❑ 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 PWouncl 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 s ft.) Proposed (sq. ft.) (Gals/day /s _ ft.) (Min. /inch) Q Elevation YL5 7 � 3 7 ,33 !, Feet Paz 7Feet Capacit VII. TANK in allo s Total # of Prefab. Site Fiber- Exper- INFORMATION g Gallons Tanks Manufacturer's Name Concrete C on- Steel glass Plastic App New Existing strutted Tanks Tanks eptic Tank Lfl�'i� /� f El El ❑ El El Lift Pump Tank /S n am e r 9 1 ❑ I ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum ' ame: (Print) Plumb 's Signature: o mps) MPIM&R mod.: Business Phone Number: so Plumber's dress (Street, City, State, Zip ode): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater LDa I ssued Issuing A ighature (No Stamps) Approved F1 - urcharge Fee) Owner Given Initial C 7 Win 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. 11. 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. Completeline 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 81/2 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; um performance curve; um model and um manufacturer; D) cross section P pP pump pump 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. Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda I Blanchard, Secretary June 01, 1999 CUST ID No.267341 ATTN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/01/2001 Ident Numbers Transaction ID No. 228842 Site ID No. 173405 SITE: Please refer to both identification numbers, Site ID: 173405 above, in all correspondence with the agency. ST CROIX County, Town of SOMERSET; 180TH AVE NWI /4, NE 1/4, SEC. 5, T30N, R19W Lot 3 OF CEDAR VALLEY ESTATES AARON & STACY MILLER 180TH AVE FOR: Description: MOUND SYSTEM FOR AARON & STACY MILLER Object Type: POWT System Regulated Object ID No.: 471512 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/24/1999 .- ! FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 KEIT A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US WiSMART code: 7633 RECIFIVED -- JUN 0 ? 1999 COUNTY ';� 2'ONINGOFFC- A Page of 6 MOUND SYSTEM FOR A. BEDROOM RESIDENCE LOCATED IN THE ' OF THE NE 1/4 OF SECTION S , T IZJ N;' R lq W, COUNTY WISCO NSIN. TOWN OF S O I"'1 �Z,S � . 5 i CA2 -E1lX � L.oT 3 OF � -�fct2 V��( ESTt�s - INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW+CROSS SECTION : of MouN 6 PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER C R.o s s Sv tx I o r ` PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ly. 01 N �'lEh -� Ga►J Lq �� PREPARED BY WECEF;ZEF2 SQ I L TEST I ht CC AND. a'{66NN P.O.W.T.S LEES 2 GN E3EFZv I c E ; \SCOAF Conditionally �� F.O. BDX 74 42i K. tSAIK ST. APPROVED RIVQ? FALLS. NI 54022 7is- 4�.�jas ARTHUR OF COMMERCE ae,sr �ts woRn,, DIVISION OF SAFETY AND BUILDINGS ESE CORRESPONDENCE 2 z Y JOB NO. p � — - - -- CP x � � �.g54 fl� �r..Mr'ctT, to Gt�Z mob, x L ; � x as s 5 \ �o' k tt 40 9 Cr�p a�1 C evations unless otherwise noted. h lateral. required) ved caps. ( Z required) ty manufactured by 360 event ponding at the uphill side. MAY -28 -99 FRI 01:22 PM NE,LSEN WEBER SURVEYING M 1 715 425 6864 P.04 Page 3 Of Approved Synthetic Covering Distribution PiPe G 3:B Medium S b P 0 /o e SIo Bed Of 2 �« Force Moin Plowed 2 '2 Aggregate From Pump Layer D 1.1 Ft. Cross Section Of A Mound System Using �OV� A Bed For The Absorption Area G 1• U Ft. A a Ft. H 1.5 Ft. - Q.S`1 F B Ft. Linear Loading Rate GPD/LN '�,' g Design ,Loading Rate= t• /SQ F I ��� Ft. Ft. K Ft. �41 term Position L i Ft, of Force Main W �� Ft. i 0 nervation Pipe 7 Distribution Bed ,Of Pipe J' i Aggregate Observat'on Pipe Permanent Markers (7.Rcl�br ,r'Sg��e ly 'J r r Plan View Of Mound Using A Bed For The Absorption Area MAY -28 -99 FRI 01:22 PM NELSEN, W EB €R SURVEYING 1 715 425 6864 r'•10Z) Page Of Perlo ► bled P ipe Deloil 0 End View ) Perforated Eno Cop > PVC Pipe ke l . C°` Install permanent at end of each lateral. Holes Located On Bollom, Are Equally Spaced ' Q S P PVC Monifo3d Pipe ~ PVC Force Main Dist($ upon Pive t_osi Hole Should Be Next To End Cop End Cap P 21 _ZS Ft. Dislribuiion Pipe, Layout S Ft. X 3p Inches Y 3o Inches Hole Diameter ' 1 `( Inch Lateral 1 f1 In Manifold Z Inches Force Main `L Inches # of holes /pi pe_q -- Invert Elevation of Laterals N at Y- L. 1,l_ gyp. Sa� Y -4= \�1 Vt Place 1st hole V& N from center of manifold with succeeding holes t intervals. 3� intervals. Last hole to be next to the end cap. MAY -28 -99 FRI 01:23 PM NELSEN WEBER SURVEYING 1 715 425 6864 P.06 FAGS � OF PUMP CHAMBER CR055 SECTION AND SPE[IFICATI01\IS - T P vEi`► cA 4' c..-L. VE NT PIPC WEATH PROOF APPROVED LOCKING RANHOLE JUIJGTIOM 80X COVER WITH WARNING LABEL 1O' FROM DOOR, (Z WIMOOW OR FRESH I AIR INTAKE I OILADI -It X24 - i � � I9• MIU. COWDUIT PROVIDE IIJLE7 AIRT1611T SEAL 7 APPROVED JOINTS APPROVED JOI A Tank construction shall comply I I with ZLHR 83.15 and ILHR 83.20 ALARM I II 0 I I I I orl c I 1 - - CLCV �_ 3.00 FT. PUMP 1 OFF O I COWCKETE BLOCK 3" APPROVE FuseR, EXIT PCRMIT(ED OWL'S IF TAN1t MANUFAC7UFLCR HAS SUCH APPROVAL REDOING SPECIFICATIOAIS TA MAyuFACYURCR: �I ZV�zy 1.yE' •t�.S NUMDIiR OF,DOSCS: 3.31° P C R , 043 TANK SIZE: 'Boa GALLONS DOSE VOLUME ALA RK P.IWUFACTVitCR: �•`S•�QC Q S�tSRY^ S 1141 -U0IWG BACKFLOW% GALLONS Amu. klumBER: 1.0L "W CAPACITICS: A= �A IUC41CSOR . 0 WLL0►13 SWITCH TyPC. Y -km L�„ e t Z ILICHES OR ' 6pLLOWS PUMP XAMUFACTURCR: ^ �A ms C -7 INCHES OR S GAI..LOWS MODEL LIUKBER: S 2 D IAIGHES OR Z"3�- O GAI LOlJ6 JWtTGN TyVE; ✓1N1Z ° LCIf� uoTE: PUMP APJD ALARM ARC YO BE ' tt 2 - INSTALLED OU SEPARATE CIKCUITS MIWIMUM DISCHARGE RATE GPM VORTICAL^ DIFFERENCE 5ETWEEW PUMP OFF A UD..015TRIbLITIOW PIPE.. FEET + nlNlnuM NETWORK SUPPLY PRE55UREE . , . , . . . . . . 2.50 FEET .+ FEET OF FORCC MAIM X 3 ' - F/oor,FKICTIOLI FACTOR.. O` FEET TOTAL D!JWAMIC HEAD = I""' ' FEET DIAMETER 114TERLIAL DIME WSIOMf of - rAWK: LEW&TH 1 :WIDTH - DEPTH BOTTOM AREA 231= GAL /INCA: AS PER MANUFACTURER -� 1�•S GAL /INCH ' 1 \ • - 010 mom Nor, No 0 am M .■■ ONE ME am ■ ■ ■ ■NI' ■E ■ YAM ■■ /NOON■/ ON a Mm MEANS m ■■■■■■a■ ■ /■ ■ ■■■r,e ■ ■11 ■N■ ■ • ■■ /■■■NONE ■■ ■E ■EE / / ■EE / ■ ■ ■ ■E ■r■ ■ EWoman ■ ■M ■ No - lMEN M■ ■■■ ■ SEEM SO 0 a a a MOYA ME a 0 Now e • MEN N■ ■EM ■N ■ MESA ■ ■ ■■NONE ON■■■ E■ ■E■ U SE ■■■ ■ ■ ■ / ■EMEE ■ / ■r■ � MN ■�E■NE ■N■ ■■■■E■0 1101 rCM■ ■� ■ ■E ■N 1EEMEEEM ■N ONE o ■■■ ■ ■r ■E /1 ■Er ■ /Enr■ ■ f ■e C■ ■EC ■■l�iO MEN t■ ■E■�iEN■ C J oan /NOON/ ■ r� ■■■ ■E ■ ■E ■E ■ ■ ■■ ■ ■N.■ ■N ■E■ I ■� room" ■NONE ■mom ■ • ■■■■MEM■NE11 ■■ /■■■■■EEM■■■■■g■■ , ■ ■ ■ ■N ■ MEN /ni %E■■ ■ MEMO ■■■ ■ ■ /_;S r i ■E■■ i n No linrl ■ ■EEN ■■ / ■M■ ■ ■ ■1� /� g ■■■ ■11■► /ME ■■■■■■ ■N■ ■0 ■■ .. ■N■101M.MO ■ ■■■■■ ■N ■Mr ■E■ • ■ MEN 11 /I ■■■E■EEE■■ MEN■ ' MEMO ■E ►I ■ ■ ENEM ■■m �. ■ ■N■ � ■ ■■ ■/M ■ ■M■■■■ I MEMNON No ■■ ONE ■r 1E■ i ' M� MEN SOME ■M■ ■ 1► 1r1E - EM ■E■ ■■ ' C E■ CC W HEN C ■E■IBUNN■EM■Ci on r N■C EECE► rE■.= ■MN■■N■Mr1■■■ ■NJ i ■ NOON `E■r�■rEEE r1Ne■iiiii ■E • ■ ■EMN■" E■n■ ■M■■■■■■ NEESE ■ ■E■■ ■ir�r�►�■E■Er�«■M■■■■� ■ „ ■ Oran ■MOMMOMMME iiriii� i ■Nno ■■ N■■� NKIN • ■■■■ ■rr,■/r ■� ■/r� ■rrr■■■rre■ ■EM■ ■■r/ ■M■ ■ ■N■ ■■■■■■■■ ■M■■I ■ ■M■■MrN ■M■�■ ■MEE ■r■ME�MEN ■ w /N 0 ■ ■EM■NNOM J I M ■■■E ■N■■■ ■E■ IN■■ ■ ■EEE■EOE■■E■ME M 0i ONC��0 No ENMEM OiiiiiiNN■■■■■ . ■ ■.0 ■N� ■e =NMI m olliiiiiiommoms • . ■N.E.e ■�IE■■■■M■NMENEM■■■M■Noun M E40 erie M S 4/10 ffluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N W 30 ~~j � W z 25 8 Z H O 20 6 J _ < 15 J 10— 4 p 10 ~ 2 5 0 0 0 10 2 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. I 11 � tc+ iN I ( -\ w,• Vol" ntry, SOIL AMD SITE lEVALUATiOrJ REPOF Prvae_ I _of _' i"I' Or r wrxl I frxnnrt ftolgUans tV SArAty/ A DIAIAnQr. Irt „ ,4 fn(1 it.litt it:t r> vVi A , ;4 it. Gt)( e Attach complete site plan on paper.not less than 8112 x 11 inchr, a in nlzp..Plan mustinclude' but St Croix ° not limited to vortical and horizontal reference point (BfUt), dtrection,and Yo of slope. state or. PARCEL I.D. N dimensloned, north wow. and location and distance to. nearest toad. 0 3 2 - 2017 - 3 0 APPLICANT INF ATION -P S P hMT- .AU -1Ni 0`-iATION REVIEWED BY DATE PROPERTY OW R c� Pt30Pl:HTYLQGA7tON Mike Ltul / GOVT. LOT NW tie E 1/4,S5 T30 •N•R 19 IE (a) W PROPERTY OWNF_R'Z MAILING ADDRES LOT •+ BLACK r SURD: NAME OR CSM 0 2040 Oriole Ave..N. Esta CITY, STATE _.,. :ZIP CODE PHONE NUMB :.. . Win':' (]VILLAGE gjfOWN NEA EST ROAD Stillwater • MN. ! i 1 .Somerset 180th. Ave. - [ x New Comifuetion Use [74 Residential / Number a bettrvoms 3'_ [ ] Addition to existing building t l Replacement t l Public or cQmmercial destxitie , Code derived dally flow ._ r)O_gpd Ra omavrxfed des gn lr li rats _ _ t M. g;xilft trench, gpdr'ft Absorption area required _ 75 bed. ft 375 trendy fy urn design loading rate __ bed, gNAt 9Pdllt Recommended infiltration surface etevation(sj ft (as referred to0a fIw Ijer nm Additional design 1 site considerations sys a s_on contour i i n t Parent material pitted — glacial ed glacial drift Flood plain elevat , ' it �U_I-U Me fol. system CONYENilONR1 MOUND 1NGrtOtJNDPnESSUriE ATGMDE SYST(M PJ FlLL rKJIDNIG TAW table for stem ❑ S [U [� S D U [I l U ❑ S [3d1 El Gt D S �c7 U SOIL DESCRIPTION REPORT : 3oring # Horizon Depth Dominant Color Nio' 9 Structure Cortsist>rnce ecuxialy hoots GP U %ft in. Munseli 0). S1 r 4 1i Gr. Sz. Sh. Bed rerdr KY 2 10-16 10vr 4Z4 GIL s _ \ r mfr aw If .5 .6 Grot>nd �1 A Gfo j: ' _8, ft �v, co+ o , 'Iepth to _ c: faft 28" - — Remarks: Boring # 1 0 -19 - 10 r 3 2 •• none sil 2msbk mfr dl 2f .5 !.6 �7t , 31 2 19 -28 10 r 4/4 . none ail lmsbk mfr if .2 .3 Grotxrcl 3 28-40 na na n .2 t elev. 191 1 Depth In ft [ d limiting 28 ilta 9g N UNN RClllat'iCS: 7ONINV OFFICE CST Name; -- Please Print G L. Steel : , . ' Phone: 715- 246 -6200 � Address: 1554 20 0th. A %re? -!cxv Ricb t . I 54017 viAo;6n Department of industry SOIL AND SITE EVALUATION RE Page 1 of __3_ } t1bor and Human Relations Division of Safety & Wkkngs in accord with 1LHR 83.05, Wi Adm. Code CO Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 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. 032-2 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Mike Lundberg Goer. LOT NW 1/4 1/4,S5 T30 ,N,R 19 X (a) w PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2040 Oriole Ave. N. CITY, STATE ZIP CODE PHONE NUMBER OCITY VILLAGE K'OWN NEA EST ROAD Stillwater, 55082 (6 Somerset 180th. Ave. 14 New Construction Use [x] Residential / Number of bedroo 3 } A ddition to existing building [ } Replacement ] ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _. _ bed, gpolft _ trench, gpd1it Absorption area required 375 bed, 9 375 trench, ft Ma)amum design loading rate ___,,_ gpd/ft WW Recommended infiltration surface elevation(s) 9R . QQ ft (as referred to site plan benchmark) Additional design / site considerations system el . based on contour line of el. 97.900 Parent material Pitted glacial drift Flood plain elevation, if applicable fla — ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDM TAW = Unsuitable for tern 0 S (RU ®S 0U 0 S 10 U 0 S (111 0 S au 0 S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bled Trench 1 1 0- r mfr aw if .5 .6 Ground elev. 98 ft. Depth to limiting factor 28 Remarks: Boring # 1 0 -19 10 r 3/2 none sil 2msbk mfr dl 2f .5 .6 F 2 h 2 19 -28 10 r 414 none Bil lm sbk mfr QW if .2 .3 .,..�;.;:..:. Ground 3 28-40 7.5vr 4 m na na na ia : .2 elev. 98 ..9_ ft. Depth to TEK limiting factor �� fill ` iv : NTY Remarks: - p ".OL ,VNG OFFICE CST Name -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Av . New Ric I 5401.7 Signature: Date: CST Number: m02298 t .k 5 -30 -97 PRoPEITYOWNEB_ Mike Lundberg SOIL DESCRIPTION REPORT Paged of PARCEL I.D. rt �- Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxkry Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench L 1 Ground elev. 95 ft. 4 Depth to limiting facto 27" Remarks: Boring # ..�i.�. Ground elev. ft• Depth to Umrfing faCbr Remarks: Boring # 1 Ground elev. Depth n. to limiting facror Remarks: Boring # I Ground elev. ft. Depth to limiting factor i PRoPEM.OWNER. Mike Lundberg SOIL DESCRIPTION REPORT Page _2.of 3 PARCEL I:D. i R Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxbry Roots GP D /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tte 6 3 1 — Ground elev. 95 ft. 4 Depth to tlmifing factor 27" Remarks: Boring # Ground Depth etev. ft. to amiting lector Remarks: Boring # Ground Depth e1ev. ft. to limiting factor Remarks: Boring # Gmund elev. ft. Depth to limiting factor r STEELS SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Mike Lundberg New Richmond, W1 54017 MPRSW 3254 NWANEk S5 T3014 -R19w (715) 24"200 town of Sawrset lot #3 -Cedar Valley Estates N 11} -4 BM.= nail in Elm tree el. 100' Alt. EM.= top of wood stake C el. 94.7' w � r --o Gary L. Steel 5 -30 -97 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer A q Q oa _} AAC rn Mailing Address 1 4 o j Am f - Kp t otj Property Address / ] a 0k q& .5t _Son.,CR 1-W , w .5y0A� (Verification required from Planning Department for new construction) City /State S wv%e2 w� W Parcel Identification Number s 3�• 1?, 10o2 LEGAL DESCRIPTION Property Location Nw ' /�, _ ' /�, Sec. T N - R - A - _W, Town of ,�or►,�QS.�� Subdivision CFA VA l IT FLS4,o &S , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # -6 , Volume Page # © � Spec house Ll yes 9 no Lot lines identifiable 63 O no SYSTE MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out tine 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, jomrreyman plumber, rest►icted 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. 1 /we, file undersigned have read the above reyiiirenrents and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the fDepailment 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. 1 1 6/7/ SI 'NATURE 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA'1T1RE OF APPLICANT DATE * * * * ** Any information that is iris- represented may result in the sanitary permit being revoked by the Zoning Department.""" ** Inrt+ale 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 590403 Warranty Deed 0F; ICE . " This Deed• made bttN%cen LUNDGO CORP., A MINNESOTA ST cR 9 Co.. tyI CORPORATION , Grantor(s) and AA E. MILLER AND STACY L MILLER, NOV 0 8 1998 HUSBAND AND WIFE, Grantee(s). 9':00 i . d Itf"'-- - ' 1 4 " . J. WITNESSETH, That the Said Grantor(s), for a % aluable considcration conveys to Grants -c(s) the follo%%ing desrribcd IRIS SPACE DESERVED FOR RECORDING -ATA real estate in ST CROIX County. State of Wisconsin. NAME AND RETURN ADDRESS LOT 3 CEDAR VALLEY ESTATES IN THE TOWN OF SOMERSET, ST CROIX COUNTY, WISCONSIN TRANSFER FAp — jCxE — tj IFICA I ION NUMBER FEF 'A y. This is homestead property. Together with all and singular the hereditainents and appurtenances thereunto belonging And above named grantors warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances except any casements, restrictions and reser% ations of record. municipal and zoning ordinances, and will warrant and defend same Dated October 30, 1998 (SEAL) (SEAL) LUNDGO CORP (SEAL) _(SEAL) MICHAEL C. LUNDBERG, PRESIDENT AUTHENTICATION ACKNOWLEDGMENT Sigim ire(a) authenticated: October 30, 1998 state )SS. ST CROIX County. Pemmally carne Nfore ine on October 30. 1998 the above THILE. NlEkWER STATE BAR OF �OSCONSIN married LUNDGO CORP.. A MINNESOTA CORPORATION to 1 be known to he the per n(%) %%Iw executed the loregoing instrunwrit WVJ acknowkrdw the %arne. THIS IN'SIRUNIFNT AAS DR.AF HY: -- (type or print) N,*-v-, Public, ST CROI County. Wiscomin KRISTINA OGLANC - ATTORNEY Nf%> I . R! i -pen-rient (Ifiwt. state expiralim djl,!: HUDSON, WI 54016 3P / Vol V UI W m P. A D N D I � (1i �tio A bJ! m m m n jr a r om p � � I a► G2 I w M I SA4 601 M i � I i 5.00' -�' N 275.00' C,— — F3 /Z Z� S01 ° 31'06 "E ,.� 80.00' E17 �t i "p — ��/ co -n < a cn I \ 99� w C \ �L Ch m OD 0 W N \ U N 2 \ o m b` \ to m loll CS j�� 8 1 /_� — m N 0 20' 1 28.69 " E pUBL 1C� $ 4, CIO g .... / cS' Z6 i-4 b 1 � 1 N \9 � \ o \ w \ U T •A ac ! N 1