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HomeMy WebLinkAbout032-2110-10-000 ST. CROIX COUNTY ZONING DEPARTMENT Ni AS BUILT SANITARY REPORT ECEIVED Owner A Property Address `C } X99 City /State - - ��, r n ZONING OF ✓,� Legal Description: Lot Block Subdivision/CSM # ' 4L t /4 Wl z — t /a, Sec. �, T —N -RAW, Town of PIN # r9.�- ,V / & -i� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC /,= /rte Setback from: House --;�„/ Well?z P/L Pump manufacturer Model 6� �� s--/ /t Alarm location S (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width e Length ly_ Number of Trenches Setback from: House Well P/L &L Vent to fresh air intake s ELEVATIONS Description of benchmark Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet 3� PC Inlet 31.,2,75 PC Bottom ; Header/Manifold ,9 2 7 Top of ST/PC Manhole Cover Distribution Lines Bottom of System () () ( ) Final Grade () () ( ) Date of installation / IP 9 Pe mit number 9 State plan number Plumber's signatur License number �y2ZZ Date Inspector iza Complete plot plan � 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 alternat benchmark, if applicable. PLAN VIEW C �Y 3 1 INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CRO IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338959 Permit Holder's Name: ❑ City ❑ Village g] Town of: State Plan ID No.: HA UKOM, CHAR SOMERSET o?a .2 5 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032 - 2110 -10 -000 TANK INFORMATION ELEVATION DATA A9900215 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic "O Benchmark Dosi ng W e e-U •CD , 6/�1 ?1. yo Aeration Bldg. Sewer 1q.42- �. Holding St/ Ht Inlet q.� $(. <-y TANK SETBACK INFORMATION St/ Ht Outlet q, SO . ? 2 TANKTO P/L WELL BLDG. Ai Intake ROAD Dt Inlet Septic >25 6L r I 's NA Dt Bottom Z 3 - 3z 7 Dosing >2- 33'+ Z� as' NA Header /Man. Aeration A Dist. Pipe qS, 41.- Holding Bot. System S SD 4 �, 3Z PUMP / SIPHON INFORMATION Final Grade Manufacturer Demycl Z Model Number W60 - 11 14 3� GPM TDH Lift L oss I.It, riction System a, TD 10 Ft H ead Forcemain Length (05 Dia. Dist. To Well SOIL ABSORPTION SYSTEM {(}E{¢}F- Width , Length t N Qf s PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 6 3 1 1 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer: INFORMATION Type Of f CHAMBER Model Number: System: Z J�� 7 OR UNIT DISTRIBUTION SYSTEM Header/Manifold a Distribution Pipe(s) , / Z x Hole ize r << x Hole Spacing Vent To Air Intake Length —q!— Dia. 2 Length 42j2_ Dia. 1 Spacing ,Y g u SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Red/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) ' ( a f qY, 32- ftp— 1 3;14o 1 � LOCATION: SOMERSET L 5.30.19,NE,NE 1777 46TH ST - CEDA VALLEY LOT 11 n 2�• 0 ( e.c�,er s cil� �'Z 4 ^�ei�. CJ I - vie-, u as ,r• ��a�Q� o-- cr+ 1 ce4)* ii,,AI� u laf >1$Ut B Plan revision qulred? [ ® No Use other side for additional information. 01 03 t1D b SBD -6710 (R.3/97) Date Inspector's Signature Cert. No w , ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a , F { ... ,,.� a � F _. , , a , , , a a s E e , { � � f ' 4 � a " L, 3 e � r a {{ 2 .. , P. e i 3 � .4. ,.�.. .< ..... .. ......r ..,.� � - ---- , S 8 H C ` J, > n, ,.m _._ i � t , ,a, a m ,e ,( a amp_ .. ��. .. e , ..,.q Y 3 .a 3 „ d � „ ,.. .. ., . , ,,. ... ,m ------- a f 3 f � S � e [ ! i .«.. .. , ..� m e.. 3 „ a,s E ? 3 E g e t ; e E e i a s E ,.. e. , ,.... ., A e a a a s E a k F ca c i e S i A sconsin Safety and Buildings Division S ANITARY PERMIT APPLICATION 2 01 W. Washington Avenue In accord with ILHR 8105, 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 Count 9 � _ �e than 8 1/2 x 11 inches in size. ; • See reverse side for instructions for completing this application State sanitary Permit Number 3 3%1 �> Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D.'Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Prop ert =0;Nj Property Location _ 1 1 /4, S T , N, R E (or& Property Owner's Mailing Address Lot Numb r Block mber 7 City, tate Ip Code Phone Number 5 bdivis Name o C Number IL T YPE OF BUILDING: (check one) ❑ State Owned W ❑ It Nearest Road El ? Vil Public Ej 1 or 2 Family Dwelling - No. of bedrooms 4 1=n OF s! 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo L 5.3o. vl tozpk 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 online B, if applicable) A) 1 14 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an _System 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 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Pr 42 Pit Priv See page Trench 22 In- Ground ressu e ❑ Y ❑ 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. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation s— Feet Feet Capacit VII TANK , in g all o ns Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existin strutted Tanks Tanks rr�� Septic Tank or Holding Tank ^— Jai ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ® — ® El El ❑ 11 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i aliation of the onsite sewage system shown on the attached plans. Pl�me Na : (P rtt� Plumb ' Ign : ( m ) MP /MPRSW No.: Business Phone Number: Plumber's Addre s (Street ity, State, Zip Co e): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssued IssuingAcibrit Signature (No Stamps) A ❑ Surcharge Fee) pproved Owner Given Initial (( Adverse De / X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.1 1197) 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 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: 1. 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 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; 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. e 4 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 J. Blanchard, Secretary May 24, 1999 CUST ID No.224263 ATTN: POWTS INSPECTOR ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 05/24/2001 Identification Numbers Transaction ID No. 228255 Site ID No. 173122 SITE• Please refer to both identification numbers, Site ID: 173122 above, in all correspondence with the agency. ST CROIX County, Town of SOMERSET; 46TH ST, SOMERSET NEIA, NEIA, S5, T30N, R19W LUNDGO CORP 46TH ST, SOMERSET FOR: Description: MOUND SYSTEM FOR LUNDCO CORPORATION Object Type: POWT System Regulated Object ID No.: 470615 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. The following conditions shall be met prior to issuance of the sanitary permit: • On page #5, the entry for "System head" shall be changed to 2.5 (feet). The total dynamic head and metric conversions shall be changed accordingly. • Page #6 shall be entitled "Pump Curve." • Page #7 shall be entitled "Plot Plan." 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 05/19/1999 t (� tnteggra FEE RE Q UIRE D $ 180.00 FEE RECEIVED $ 180.00 WILKINSON , POWTS PLAN REVIEWER BALANCE DUE $ 0.00 IServices (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US WiSMART code: 7633 l <<, o f RESIDENTIAL MOUND DESIGN �y. INDEX AND TITLE SHEET Project LUNDCO CORP. Cy Owner MIKE LUNDBERG Address 2040 ORIOLE AVE NORTH STILLWATER MN 55082 Legal Description NE -NE -SEC 5- T30N -R19W Township SOMERSET County ST. CROIX Subdivision Name CEDA VALLY ESTATES Lot No. 11 Parcel ID Number p Number Conditionally INDEX SHEET PAGE ONE AP P ROVE D MOUND CALCULATIONS PAGE TWO DEPARTMENT OF COMMERCE MOUND DRAWINGS PAGE THREE I`lISION OF SAFETY AND BUILDINGS PRIES. DIST. CALCS. & LATERALS PAGE FOUR ►n. UMP TANK DRAWINGS PAGE FIVE E CORRESPONDENCE PUMP CURVE PAGE SIX PLOT PLAN PAGE SEVEN Designer KIM A O' NNELL T License Number Signature Phone No. 715-755 -3145 Date 5 -17 -99 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification wits result In disciplinary action under s. 146.10, VAs. Stats. SBD- 10482 -E (R.04197) Page 1 of 7 RESIDENTIAL MOUND DESIGN Eight Bedroom Maximum Com eta n on i red h~amed bom as necessary. (y or n) r n Is the em over orwic5ed bedrock? slope % Number of bedrooms 3 Wastewater flaw rate 450 gpd 1703.3 Lpd Depth to limiting factor 28 in 71.1 1cm in situ son Waradon rate (code) &S JWdif 1 20.4 jLhW Contow Nee belcwthe of absorption call 1 94.24 ft 28.72 m Use Ord fill depfs? x OR Des ww speck! dept# — m cat► Place X In box to use shndard depths (rz 24, A+4 ktcktsfve) OR specffy design W depth►. Center or aid marrifoid a (car*) Estimated hole space 4 ft Hot a 'kw cakub doo. Lateral spacing 3 ft Wrimum dose >= 10 times void volume Use a 0 kwwW spe ckrg for trenches. Pump tank elevation 63 ft Outside bottom Of tank. Number of laterals 9 1ft Fore main d larrm ter 2 in Fore main length Force main act da. I 2057 in MMTEM SOLUTIONS lwh- pounds Male is Ceff media "x" one only. Estimated daily flow gpd 1703 Lpd x Aggregate and and pipe Abs ptim cell Design load rate & area =Ipde 375.0 fe 34.84 m? Linear load rye 7.1 gpdfft 88.0 Lpdfm Design vift (A) B ft 83 m Cell length (8) 63.0 ft 19.2 m Depth of tell (F) 9.9 in 2,5.1 cm Sand fiher Updope fill depth (D) 12.0 in lflrr? cm Do�op�er fill depth (E) 17.0 In cm Basal area r�e"Wed ( i�ltration rate) 900 fe Supporting components Topsoil depth 8.0 in 15.2 cm Subsoil depth at comer 12.0 In 30.4 cm Subsoil depth at cell waft 6.0 in 15.2 cm End slope toe length (K) 10.6 ft 3.23 m Upelope toe length (J) 7.0 ft 2.13 m Dow wk" toe length (1) 12.3 ft 3.75 m Total mound lath (L) 84.2 ft 25.88 m Total mound ARM (W) 25.3 ft 7.71 m Project: LUNDCO CORP. Plan I.D Page 2 of 7 MOUND PLAN VIEW ► j _ 7.71 m -- A ` A_ 6.0ft M m F, -- B - 83 ft m 7. ft m } l 12. ft 3.75 m -- --- K = 10.6 ft 84.2 ft G 25.71m refers to tf►P� ol�s. pipe X B motion cal width and length {anchored seaxeW j _ updcpe width I = dovAvdope vwidEh V K = end slope dimenshut (t5o mm} MOUND CROSS SECTION lateral topsoil "I" � subsoil cap D = 1 2.0 in 30.5 cm 96.7 ft G E - 17.0 in 43;2 cm elev. F- 9; in 25.1 cm elev. 2S 17 to see note G = 12.0 in 30.4 cm H= 18.0 in 45.8 cm / 4 D E ` I1S€IYf C3'j SYS 85.2 ft F Sand F* elev. 29.02 Fri z 94.2 contour 7% Im slope ' F Nde: Absarptim cell mecu wN 0 = hope fill depth pbMMed layer cone<eC a aggregate wind pips E _= � fill or Jw1vng ctwnbars and pipe F = absorption cell depth as specAw A e G = + topspji h at Celt wall at 69W. F q Chamber H = subsoil + topsoil depth at cell center Dedow notes IF awe is used, it IS ODVWW %dh code compilant material Project: LUNDCO C ORP. Plan I.D. Page 3 of 7 I PRESSURE DISTRIBUTION CALCULATIONS Absorption con indHvuncw Medic Vvdh (A) 8 ft 1 1.83 Im Length (B) 83.0 [t 19.2 Im Lateral Number laterals Holes/lateral 18 holes Lateral length 6D.0 ft 18.3 m Perforation rya. 0.28 in 6.4 mm Lat. dis. rate 18.84 Imm 1.2 Lis Sys. d i& nde 37.28 -- I wn 2.4 Us Mate spadM 48 l in 121.9 Cm Lateral dMineter POO dbMdK mift . out aim. Destrw nwst 1Ingo wn Place X in nerd w)( one t f imnW baK of chosen hwn the opflons i law4a mm x x diarnete provkw mm x x Manifold dlatteter P09 dWadw Da@ 00sim r amw jwzmm , 7r one shotrme i fit nrn Puce X in rod ftm the drpfiarts i ir2w4o mrn X X b©nr of chosen pnwkbd iQmm x diameter 3kM mm x R M — W tnn x Distribution system oontains 2 tateral(s}. L ATEM DIAGRM - END CONNECTION place correct /steno/ degra by ckkM in om at the arawings at right and dragging the ciagram into this aroa. East t�ctt tkweQ new io snd cep - �"oap � R r Atl tatera� art ider�tca{ l+r- }C — DF� totes dtlfed on eha Caaots ar the tatatat Eacetrr�iaac�ateattattt�tQeorcxasstarttarl�x t LaterakoQa FtaMM nor PVC &* 40 • pesmann�trndnurkaE (parCM64TAk94.3Q -% Inch-pounds Metric Lateral length (P) 80.0 ft 18.29 m Later spec ft (S) 3 ft 0:81 m Marifdd length 3 ft 0.91 m Hole ckimeter 0.25 in 6.35 mm Lateral dframeter 1.5 in a 40 mm Number of holes per ppe 18 Invert elevation of lames 95.7 ft 29.07 m RcOct LUNDCO CORP. Pleat I. D Page 4 of 7 CORRECTION NEEDED SEE CORRESPONDENCE Total *rWnlc head System heat = 3.25 lr� verdc;W lift = 11.50 ft 3.W m Are WI& the l WWd pok,c k, the Frictia� lass = 2.67 ft "EMM y es ov hers: x m Total dynamic heard , 72 5.40 If nO, � Is the h%owet dadion Done Volume dMwohmn of ptmp? �� Lateral void volume = 12.7 goi 48. L F rai Force mem dn KnImum dose = 127.0 gal 480 7 L -wit to teak? (V one) Chain back = 20.0 gal 75.7 L x Yes Dose vdume = 147.0 566,5 EM Typical Pump Chamber Layout In combustion with state approved tretment t k Tanis comas ion as per Comm 83.20(3) WAC. pwa *&wnkv iebat and polo* graft WAIS Orsdim box '1.1, alterrrace _ e wt pipe G6W*1c as per MEG MD and -: arttet cam teas WAC bcadon t$M (46 cm) mkti w d of pump epprow d ahe6er or ,outlet wmbkwan t+e* A 1J4" raR and* d* revels alarm on k IMP B hors a s ^ter "wft* wA* has amn min . do..fidana - 60& l 83.9 ft. vat: 300 naa >.a,warai rre.ee Off elev. 25.6 m 3 " mm Of kwdsrtw* fords as raossmy 83.0 h PWW tank dwA im 25.3 I m bottom Of tank Tank. spetaficatiatts: WEEKS p tw* = 1f . g Pump tank vokow - Capacifies Inches Gallons A= 24.3 462.6 Pump marlufac rer: QOtJLDS B= 2 38.1 Pump model number: 3t1M C = 7.7 147.0 10 8 152.3 Project: LUNDCQ CORP, " Plan I.D Page 5 of 7 Cu rves CORRECTION NEEDED P U m pS rY c/,, -C 7 SEE CORRESPONDENCE 11ETERi FEET 90 25 - `— --� -� TiMODEL39&5 SIZE 3 /4 , . Sofas WE15H - - y� 70 IT -­ _ I ?0 WEIGH 60 -� O 1s 50 - �— WEOSH f - -- I -- - — - -- - - } —. - _T ' K 10 W EOJM - - - — -I -- - -j— _� - -r� 5 20 -- - - - 10 - - �t - - -�- ol. 0 1 0 10 20 30 40 50 60 70 60 90 10J 110 120 GPM 0 10 20 30 m'Ih CAPACITY •T, �.1'1���1, aN,r G0ULD_S PUMP � N C. METERS FEET 120 M ODE L 3885 35 - SIZE 3 / 110 WE15Hn f —� SOIIdS 25 7 0 -- 20 60 — I — WE05HH — - - -� - 50 - 15 40 10- 30 20 r 5 � —- 10 r --1 — -I OL 0 — �EE 0 10 20 00 40 50 60 70 110 120 GPM 0 10 iJ 30 m'/h CAPACITY �I$" Gould& Pumps, Inc. E w awry, 1ro� CUe` - COMMON NEEDED - _ �SPOND�NCE f � I i II I� 1 i _ F i ! 1 f i I f f I - vJO I � i �i f i f I I I I i i f I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page —/— of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all information. Revie by / ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J / 3 /7G Prope Owner Property Location Govt. Lot _ 1/4 1 /4,S T N,R (or W Prope Owner's Mailing Address Lot # Bloc Subd. Name or C M # City State Zip Code Phone Number ❑ ty ❑ village F] Town Nearest Road Ci ( j) -� �(f New Construction Use: Residential / Number of bedrooms �� Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow � gpd Recommended design loading rate 5 bed, gpdflf -- trench, gpd/ft Absorption area required ?75 bed, ft 2 ZS7 trench, ft 2 _ -/ Maximum design loading rate 5 - bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) / -- ft (as referred to site plan benchmark) Additional design /site considerations Parent material e,o �� 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 ❑ S R U E4 S ❑ U ❑ S [4 U EIS O U I EIS O U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft :::.. in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench S Ground / el P Depth to limiting ; factor Remarks: Boring # 11 7 I S 3 — �� / d � / Ground _ < ' ,S Id f Al O elev. 24 - 4 ft. Depth to limiting fact r J in. Remarks: CST Name (Plea P,rin Signatu Telephone No. jJx r �S /1 Address Date CST Number PROPERTY OWNER I/AM C212��" SOIL DESCRIPTION REPORT Page--- of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground A A1,1 ele Wes. AA Depth to limiting factor m in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -8330 (R.9/98) X,,4 /'9 sic - 73D.t� 7P� /A� ��� r A111 s�.s"D9,, r X08 Wltsco= Deparanent of Industry, SOIL AND SITE EVALUATION REP rage - or � - Labor Human Relations Divi§ion of Safety 6 Buildings in accord with It_HR 83.05, Wis. Adm. Code CO Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I D. # Cro not limited to vertical and horizontal reference point {BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. 032 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,5 T 30 ,N,R jg (or) W PROPERTY OWNER'S MAIL ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2040 Oriole Ave. 11 Cedar CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE JUOWN ST RAf Stillwater. NIN. 55082 (612 436 -6172 Somerset I 180th. Ave. (� New Construction Use[ Residential /Number of bedrooms 3 [ j Addition to existing building (j Replacement [ j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _ bed, gpd1ft gpcW Absorption area required X75 bed, ft 375 trench, ft Maximum design loading rate _ bed, gpd/1t _ trench, gpd/ft Recommended infiltration surface elevation(s) 103.90 ft (as referred to site plan benchmark) Additional design /site considerations system el based on contour line of el. 102.90' Parent material pitted glacial drift Flood plain elevation, if applicable na S System CONVENTIONAL MO UND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK tem [IS fl U I ®S o U O S CRU 1 O S au ❑ ❑ S flu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPDIft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed lends 1 10-14 i 1 ry ri '? Ground 3 1 32-47 7.5vr4/4 c2ti7- 5vr5/8 sicl m na aw na n .2 dev. 1OA ,Qft• 4 1 47-60 7.5vr4/4 c2D5vr5 /8 scl lcsbk mfi na na .2': .3 Depth to limiting factor Remarks: Boring # 1 0 10yr4/3 none S1 2mar mfr aw 2171 - 5 : .6 2 P `:',`3 aw 2 12 - 10 4/4 none S1 2mar mvfr- Ifl .5 .6 na nio .2 Ground 30 9 elev. 10A,-W. .1. Deem to limiting c� - faCmr s ,j I li u R S . COUNTY Remarks: Z ONINGOFFICE CST Name:--Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th. New Richmo9d ' WI 54017 Signature: Date: 5 -26 -97 CST Number: m02298 PROPERTYOWNER Mike - jAeM --- SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # ' Boring Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tod 3 1 0 -11 2 11 -27 10 4 Ground 3 27 -35 7.5 r4 4 f1f7.5 5 elev. 100,g n• 4 35 -60 7.5 r Depth to limiting factor 27" Remarks: Boring # Y Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. Depth n to limiting factor Remarks: Boring # Ground elev. n Depth to limiting factor STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM229$ Mike Lundberg NEQNE'k S5- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -$200 t lot #13 -Cedar Valley Estates N 1 BM.= topof 2" pvc pipe @ el. 100' Alt. BM.= nail in Elm tree C el. 99.70 0,2 / zs! � 1R 30 0 X. Gary L. Steel 5- 26--97 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Aye- Lla r. k= Mailing Address (ln 1 AJl►� Propert I y Address 2 'Z c (Verification required from Planning Department for new construction) 940 City /State,; -- _ Parcel Identification Number I EQA—UESCRTPTTON Property , Location ' /,, See. T N - W, Town of Subdivision CIL,D 1� - 1? Lot # �. r — F� 7 1� Volume , Page # Warranty Deed # _ to 1 Volume _� , Page # a Spec house. O yes ono Lot lines identifiable 211yes O no SYSTFM "MAINTENANCE Improper use and maintenanccof 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 masterpluml�cr, jpttrneymattplumbq, restrictedplumberora licensed pumper verifying that (1) the on -site wastewater disposal system is propel operating Condition 4 nsi/Qr.(2) after ltlspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set (pith, hetcin, asset by the Depargnent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification statr►g that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the three year expiration date. LF /./9 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION -1(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 Apopl y , describcd Bove, by ' virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE � # * Any information that is mts- representedmay result in the sanitary permit being revoked by the Zoning Department.' * * * *• 3 n 3 § � TM InCl r ude with this app a stamped walrranty deed from the Register of Deeds office a copy of Ili +Certified survey map if reference is made in the warranty deed t ra wb , t .L 56 Warranty Deed �5�f lcE T. GRGIX CO,, w; � This Deed, made between LUNDGO CORP. A MINNESOTA NOV 1 19 , CORPORATION, Grantor(s) n and MARTIN LEROY HAUKOM AND CHARLENE ANN 9'o \ /7 HAUKOM, HUSBAND AND WIFE, Grantec-0. it.._ �►k ta1.t� �� Rra &%, v♦ D..ds WITNESSETH, That the said Grantor(s), for a valuable considerat conveys to Grantee(s) the following described THIS S °ACE RESERVED FOR RECORDING DATA real . - State In ST CROIX County State Of Wisconsm: NAME,4NORE URN ADDRESS .} I LOT 11 CEDAR VALLEY ESTATES IN THE TOWN OF 13PV 11,1 1 �ff SOMERSET, ST CROIX COUNTY, WISCONSIN EXCEPT PART TO RONALD R. GILLITZER AND JESSICA M. GILLITZER IN VOL. 1338, PAGE 310, DOC. NO. 582545. PARCEL IDENTIFICAT" )N NUMBER ? +R- « , gg yy T _• TRANSFER This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And above named grantors warrant that the title is good, Indefeasible in fee simple and free and clear of d °- except any easements, restrictions and reser.'atU . of record, municipal and zoning ordinances, and will warrant and defend same. x,R t Dated: November 12, 1998 y , i w -, (SEAL) — (SEAL) LUNDGO CORP >s • _(SEAL) (SEAL) iBY MICHAEL C. LU ERG, PRES. t �, AUTHENTICATION ACKNOWLEDGMENT ; e Signal ue(s) authenticated: Na ember 12, 1998 State of 111WGR.h% ) 1 ss- ST CROIX County.) 4 �! Personall) came before me an November I Z 1098 the above TITLE. MEMBER STATE B.AR OF WISCONSIN named LUNDGO CORP. A MINNESOTA CORPORATION to d be known to he the person(s) who `cecuted the foregoing instrument + and acknowledg THIS INSTRUMENT WAS DRAFTED BY: f (.Pe Print) Notary Public, ST CROMCoway, KRISTIN A OGLANJ, ATTGRN`Y My usson is pemwtatt ( Irnot ante expiration date: F: HUDSON, WI lll� J- —•� ' 3 k C - .� ac $o ep s � s � Z \ W ww \ N CO SO5 ° 20' 'yy Iw 48,00 1 I W \ tG W \\N - io � (10 \� M 10) 000 \N \\ N I M••�ZLS• \ \ 1 \• N V � I lb CD Cbl i 0 T9 `ti 6�y 25 �yi � �/ CD o N IN �yi I W . 1 �� 1 Q(5 OD L N OD a 1 0) N 340.00 - U) 0 92.04' : 65,82' O N N I � I • NN � '� f I , 133. I OD CD / I r4 W 1 8 Q O p \ �V fw 92.04' •� ` �� 01y vJ N01 ° 33'WrW S23 % T N 33S ' � p� NOI 17'49 W 639.13' i OD 4 W p 0 i FD X00 W m to �• NI QI I 530.73 � U► v i I