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HomeMy WebLinkAbout032-2107-60-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT y � Owner lC'9,A A- /_ n. Property Address 793 /�s' i3Ut City /State ?r'clf, v ax UJ• S%o' /7 1 sr Legal Description: r' Lot I_ Block 4(A_ Subdivision/CSM # e • Ass L it - 1 /4 A6E ' /o, Sec. //,T QN-R jW, Town of 5,i 2s` PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer L&4?L- "S Size ST/PC /, ?pro/ Setback from: House /j - ' Well P/L. ,5 S ' Pump manufacturer XA Model iYA Alarm location kh ( ING TANKS ONLY) Setbacks: Service roa es air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: T&A 6nly Width ? ` Length 7S ` Number of Trenches Z Setback from: House 3/0 Well P/L 8 Vent to fresh air intake A ELEVATIONS Description of benchmark %o " _a T 5 7 Kc= Elevation /oa.o ` Description of alternate benchmark %T A//G Elevation 9' _7S Building Sewer ST/HT Inlet E ;7 ST Outlet 4 ` PC Inlet _ A PC Bottom I YA Header/Manifold Top of ST/PC Manhole Cover Distribution Lines 9/ . 9-5� ( ) Bottom of System Final Grade Date of installation &PFjpermit number - 3 State plan number ,Q// -► Plumber's signature " License number ,2.2/ 79V D a te/ Inspector l ew , - Complete plot plan a 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. PLAN VIEW F ri. Q ro/ e q y pi—v l oo" ffov s� /,'L00 GC ST INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety find Buildings Division Count 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)]. 344615 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: Town of Somer t CST - BM Elev.: Insp. BM Elev.: BM Description: Z IA Parcel Tax No.: C T 5 aA A.-kA.&Q . 032- 2107 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic tab Benchmark Dosing Alt. BM A 3'6a Qg. a Aerati n Bldg. Sewer 3 06 q( 0 / Holding St / Ht Inlet g 9.0 (?T,�3 TANK SETBACK INFORMATION St / Ht Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic 515 0 V NA Dosing Header / Man. 9 ' ' A d .g� Aeration NA Dist. Pipe fi p q , l 86. 3 Holding Bot. System E 11.0 , PUMP/ SIPHON INFORMATION Final Grade (0 3 Manufacturer Demand St cover Model Number GPM * A qZ Ia2.G7- QS ?S TDH Lift F ' on S m TDH Ft oss Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM/It , t Q Q, �, 6 .5 4 - "W �L 1ffQ< Width f L ngth r No. enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 3 7 � DIMENSION SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufactur r: ,n � SETBACK CHAMBER ~ l �� — S1�W `w INFORMATION TypeO r Model Number: System: L 0 OR UNIT _ u DISTRIBUTION SYSTEM Header / Manifold U Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing 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.) Inspection #1: / 0 / , 8/99 Inspection #2: Location: 793 165 h Avenue, Somerset, WI (SE1 /4, NE1 /4, Section 11 T30N -R19W) - 11.30.19.1010 -Ff= Plan revision required? ❑ Yes MNo `l R � / CZ b / Use other side for additional information. S BD-671 0 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w �.. . ..... — i F _ , , a , m«� a a , - € F E s s a a.. , e e f7m,� �. IL t �b _m ,� m x E 3 S � f M e e a e- ; € n f ,_ _.... �. r a _ < a ' i i [ 4 1 i F 4 s k 5 a i ,..,., --- -- . - — ., ° 3 1 f � f t � f � m_ ®m sm �s .., s f � �11 a _ 6 3 f . , n o- m� �e R. ,m . s t � � r t � f a f i 3 a a t g s i f E J _ ...ten .....,. -e. �,m ,. ... ..... .� .. ...... ,..._. .. .. >......a'm.. .,.. �.,�.. ® ®.,.y Y - a a t i s 3 s 3 i E - ' € I i e f d f E r 10 66nsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. dope, t ,1 t Madison, WI 53707 -7302 • ' Attach complete plans (to the county copy only) for the syste , ', on papert less. County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application i ` State nitary Kerm Number 4 Personal information you provide may be used for secondary purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 7 .; I, 9, V '[ , Y State Klan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT�ALL . R Property Owner Name y Location ,�� ffi L G iff tia 114:,5 % T 30 , N R /f E (or(p Property Owner's Mailing Address R-' dr Block Number 161,5 L /`CG /?/ City, State Zip Code Phone Number Subdivision Name or CSM Number 'g e- , ss 2 1 ( N4 L - II. PE F BUILDING: (check one) E] State Owned 1 Nearest Road C] vii age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF O 6� U� III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I / . ' D 1 1 ❑ Apartment/ Condo 03, - .2 O 2 -60 —OOH 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. X] New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an ______System ________ System Tank Only Existing System Existing System B) fiQ A Sanitary Permit was previously issued. Permit Number Date Issued S —,9 V. TYPE OF SYSTEM (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure _ _ 42 ❑ Pit Privy 13 ❑ Seepage Pit L �3 X �'� 43 ❑ Vault Privy 14 ❑ System -In -Fill V , i VI. ABSO RPTION SY STEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 600 equir� q. ft.) P �sed (sq. ft.) Gals/day /sq. ft.) (Min. /inch) S� Elevation e eet Feet VII. TANK Capacity in gallons Total ,# Of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existin strutted Tanks Tanks eptic Tank k E r ® ❑ ❑ ❑ ❑ ❑ Za����l I I I ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu is Signature: (No Stamps) g PRSW N Business Phone Number: d 1217 W 7 5 `loG5 Plumber's Address (Street, City, State, Zip Code): B C.1-6 SST r O IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee [Includes Groundwater ate I ssued l issuing Agent Signature (No Stamps) W Ap proved Surcharge Fee) pp []Owner Given Initial ��, ---� _ Adverse Determination X CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: -- tr05i o� rr -r 5k4 J: , : t:r�i'� /7e1- f44— 5�r.ijr�►1�`2'•�� SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 maintain € d - The septic tank(s) must be pumped — y a licen3 {3unipet 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 Div+sioR,- 608 - 264'x3151. - 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 new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; Dj cross section of the soil absorption system if required bythe F) - soil test data on a form; a F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I ' ' 4AMe ! I jJ1Lic1.1JJ1 1M _... _ - -- — - - -- r i � ! ' � ! 1 _,_._ T - - -- - - • -- - - - - - � - - - - -- -- -- -- -+fit -- _ -•- , i I 1 _ 1 c i t ' r — 1 i s os i pAO d i ts lU ir , I N�- ��' >'?- - e7 � _. Ap ,per 1 � � 8 --- �L�__ -�— . r l��' j r � I t � f ` a f i a , ! t � - I 1 , I r Y t + � J i _ t + i i i • T !t . j . , i g i 1 tl , I y t E 1 S t • f r s t- t- v f r f ` a itt - -_ _._• -_._ t{., - ♦._.__ ! s ! y i i -------- --- 1 i Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division,of Safety and Buildings Page of Bureau of Integrated Services in accordance wlth�, �_$T09 Adm. Code 4 Attach complete site plan on paper not less than 8 1/2 x 11 inches i)R side, Plan u County include, but not limited to: vertical and horizontal reference point 0M) direction Arid , .._, , Cr � percent slope, scale or dimensions, north arrow, and location anj distance to nearest foaijf Parcel I.D. # d. APPLICANT INFORMATION - Please print all infdnnation Reviewed by Date Personal information you provide may be used for secondary purposes (PriJacy Laws 15.64 A. Property Owner / I Pro y °vacation t 4 l 61.. Govt. Lot 6'F 1/4 IV „4,S tl T 3 ' N,R Property Owner's Mailing Address - -Lpt # Bfock# Subd. Name or CSM# /1 15� 13 lac 1Lj k A - //j A � 60-rx Z-ake &f City State Zip Code Phone Number Town Nearest Road � �m ❑ City ❑ Village � (( -7 -Sc-,, ey-� New Construction Use: a Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: 7 Code derived daily flow gpd Recommended design loading rate / bed, gpd /ft gpd /ft Absorption area required_ bed, ft 7S trench, ft Maximum design loading rate bed, gpd /ft .. 6 trench, gpd /ft Recommended infiltration surface elevation(s) ?e ft (as referred to site plan benchmark) Additional design %site considerations 0 Parent material G Lamers Flood plain elevation, if applicable IV ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [2 S El 59 S El U N"S El B El ® U El [S'U ❑ S t?9 U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure Boring # P Texture Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench OC T elev.nd -3 ?j 2S�! fCL �sh� {�r s�' C s -�- G � -S . Depth to Q ! limiting factor Remarks: Boring # 3 V 7, s ,� v 6 S ©s k I tie _ 7' Ground y Q b — �S PtI Depth to limiting factor +13.) ,--in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number PROPERTY OWNER i • i t�a� �elp e.g s. SOIL DESCRIPTION REPORT Page of .- PARCEL I.D.# 63oZ ! o?10 7— I �Q Cn Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground 3 wtm 7�S s DS J . r" elev. ft. Depth to limiting v° factor in. 1^ ' Remarks: Boring # O B 16 X .,312 L a s 7.�5 / �lC s � (fi 1 • �l ' _ �" Ground ww `1 '-2 .SAK M`F . elev. Depth to limiting v fac -H 3A r 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 # �— l r2 3 �^ S� suns � fh °�� G • $�' "q kvv 7, Flp 3 J- ©i2 Ground / e QL�'t. Depth to limiting fartor - 0 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) - P -'►- rV g la* s 1 n a u i s - a Pr�c�, q - �' C�� 1 ' -, -- - i i i !' ``► Pe ' esaw, t �/ . �111h S car � a A �P/� , St & 7 1 u 5 1 Z . — _ ',, '` !.. .. _. - '. ' f is —_ �. i i — i i '. i � '. i i i _ ., i � �. '. i � ; � � '. i I ' ___ I � _. __ '', :. : I i �, : �, ', iI I _. i � � �� '., I i I i ` 1 i ,, i, I 1 �. .. i i ' .:- ! -. � i i '. ;.. i � i _ 1 1 F i -. � � , ,.. �i � ( 1 � - i i - � _ _ � � r � r ;_ _- .. -. � � - i � � 4 _ _. , i __ __ - _� __ � ! i ' ' '. ,. �; _. _ ,_ t- Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. - In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • ` Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. ! • See reverse side for instructions for completing this application State sanitary Permit N The information you provide may be used by other vernment agent pr rams ❑ Ch.3re6isibn to previo application [Privacy Law, s. 15.04 (1) (m)]. `-� Ac, State Plan I.D. Number I. APPLICATION INFORMATION - PLEAS PRINT ALL INF RMATION Property Owner Name Property Location C Q 1/4 i14, S T , N, R p E (or Property Owner's Mailing Address Lot Number Block Number g City, State Zip. Code Phone Number Subdivision Name or CSM Number 9 M Al 1 S 1 (45' 1 ) S -4tA5 11. TYPE OF BUILDING: (check one) ❑ State Owned V D ity tNea C] Village Public 0 1 or 2 Family Dwelling - No. of bedrooms 9&L Town OF O/`fLs/tS 4,6_r 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1232.— ,2.107 —Go — a ©O 1 ❑ Apartment/ Condo par 11.30 .t�1 . lc�la 2 ❑ Assembly Hall 6 ❑ Medical Facility -/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 Q Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash r S ❑ 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 W New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ______System System ____ _________TankOnly stem ______________ Existing Sy ________ Exi ------- 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 5d Seepage Trench 22 ❑ In- Ground Pressure 42E] Pit Privy 13 ❑ Seepage Pit lh ` 1 43 ❑ Vault Privy,-- 14 ❑System -In -Fill .� 3 C (Zww, !2 & 7`3 2— VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min-/inch) 95,"7 Elevation - {j d ' 763 , 2 - ; , Feet p ' ? Feet Capacit VII. TANK in l ions Total # of r Prefab. Site Fiber- Ex p er. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic A p p New Exist s tructed Tanks Tanks !r e pt, c or a-n Q ' 5 a ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu rs Signature: (No Stamps 1MA=aW Business Phone Number: v hltr - - d 6S" um is Ac dress (Street, City, State, Zip Code): 5 IX. C UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issui gent Si ature (No Stamps) pp ❑ Owner Given Initial A roved � Surcharge Fee) � /J� Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6318 (R t 1/96) 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. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Y Absorption system information. Provide all information requested g uested for numbers 1 through 7. P VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. f Uc, lT d /�Irsp now Y s t 1` — sly WOW Ar Er Jy I i , RQO -- - - - �.; lc' 7s iN i r. { 1 i 1 r f , , 1 , r , G r 4 i , 1 t _ -- : Al , -GU - -_- t r a 1 I I + i i I 1 ` t i i � • i II , s I 1 , I E E � Z I i { I { i a i E , I f I a s ; I I 1 a _ s , E 1 i l i 1 i a E l I ; +— — i -- — — — — -- — I � , f r I ! f r ; f s i f . � I • s ' Wisconsin Department of Industry SOIL AND SITE EVALUATION RUE P O R T U Page 1 of M Labor and Hyman Relations Oivision,dtSafety 8 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. 0 3 Z - - Zo 7o T APPLICANT INFORMATION- PLEASE PR INT ALL INFORMATION RMATION E ED PROPERTY OWNER: PROPERTY LOCATION r4p_rald J_ Smith GOVT. LOT SE 1/4 NE 1 / 0 11 T 30 N,R 19 F,{or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 11160 190th, Ave, N.W. 16 n;i N. 'Rags Takp RgtatpR CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD E ( 61J 441-8888 1 Somerset 85th. st. Jul New Construction Use [x] Residential / Number of bedrooms 'I ( ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate __gy bed, gpd /ft _ trench, gpd /ft bed ft trench ft Maximum d esign loading rate bed, Absorption area required 643 563 9 9 �— 9Pd /ft __B_ trench, gpd/ft Recommended infiltration surface elevation(s) c)9-7n & q4-nn ft (as referred to site plan benchmark) Additional design/ site considerations alt system el = 94.00 & 92.50' 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 for s stem ® S El ® S E) U CAS El U � E] U Ga S ❑ U [:]s CCU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -8 10 r3 3 none sl 2msbk mfr 2f .5 .6 2 8 -28 10yr4 /4 none sicl lcsbk mfr gw if „_, .2 .3 Ground 1 1 28- 84 elev. 99. ft. Depth to limiting factor +84” Remarks: Boring # 1 0 -8 10yr3/3 none S1 2msbk mfr .5 .6 Ground 97 elev. 99 ft. Depth to limiting�� factor 1 +8411 Si Ga X w Z N O Remarks: ---�— CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 204. Ave. New Richmo I 54017 Signature: Date: 4 -16 -97 CST Number: m02298 i 1 PROPERTY OWNER Gerald J. Smith SOIL DESCRIPTION REPORT Page 9 of 4 PARCEL I.D. # C" 3 r ZD Ile " 2Ci Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 -9 10 r4 3 none sl 2mcir mvfr 9w 2f .5 .6 2 -22 10yr4 /4 none sil 2mgr mvfr gw if .5 .6 Ground 3 2 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 98 ft. Depth to limiting factor +84" Remarks: Boring # 1, 0-Q i0yr3/ 9 msbk 9w 9f none -Qi 3 Mfr :..:..' Ground 3 22 -84 7.5 r4 6 none ms 0sa ml na na .7 .8 elev. 9 6.1 ft. Depth to limiting factor +84" Remarks: Boring # none sil 2msbk mfr Mine C-u-1 if 5 Ground - elev. 95.0 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Gerald Smith 1554 200th Ave. CSTM2298 SE4NE4 S11- T30N -R19w New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -6200 lot #16 -N. Bass Lake Estates N 1 BM.= top of NE lot stake @ el. 100 „n Alt. BM.= top of 2 pvc pipe @el. 95.75 1` Z � o -� 5� Gary L. Steel 4 -16 -97 TOWN OF SOMERSET SOMERSET, WISCONSIN 54025 April 14, 1999 St. Croix County Zoning Office Rod Eslinger 1101 Carmichael Road Hudson, WI 54016 Re: Lot Number for Michael and Patricia Helgeson/N. Bass Lake Estates The lot number for the Helgeson's is #16 of the North Bass Lake Estates. The Board approved their erosion control plan on April 7, 1999. The Board also approved Gary Peterson, lot #6 and William Bassamore, lot 92 - along with their erosion control plans. If you have any questions, please call me at 247 -3519. Sincerely, Jeri Koester, Clerk i pp TOWN OF SOMERSET SOMERSET, WISCONSIN 54025 April 8, 1999 St. Croix County Zoning Office Steve Fisher, Director 1101 Carmichael Road Hudson, WI 54016 Re: Release of Michael and Patricia Helgeson Sanitary Permit Dear Mr. Fisher: Enclosed is a copy of the Minutes from the April 7, 1999 Board Meeting. The Somerset Town Board has approved the erosion control plan for Michael and Patricia Helgeson's lot in North Bass Lake Estates. This letter is to inform you, or whoever is in charge of the Sanitary Permits, that it is now okay to release the Helgeson's Sanitary Permit. If you have any questions, please call me at 247 -3519 or Ed Schachtner at 247 -5982. Sincerely, W Jeri Koester, Clerk Enclosure cc: Michael and Patricia Helgeson Ui N C; TOWN OF SOMERSET REGULAR BOARD MEETING MINUTES APRIL 7, 1999 These minutes are unofficial until approved at May meeting. Chairman Schachtner called the meeting to order at 8:03 p.m. Present were Schachtner, Neumann, and Plourde. Clerk and Treasurer's Reports: Motion by Neumann, seconded by Plourde to approve the regular March meeting minutes as presented. Motion carried. All members voted yes. Motion by Neumann, seconded by Plourde to approve the March 24th Special Meeting Minutes with the name change of Patty Schachtner to Patty Reid. Motion carried. All members voted yes. Motion by Plourde, seconded by Neumann to approve the Treasurer's Report as presented. Motion carried. All members voted yes. Old Business: Bergmann Company crack sealing on town roads was discussed. Motion by Neumann, seconded by Plourde to approve $7,200 (+ or —) for crack sealing by Bergmann Company at .91 lb. Motion carried. All members voted yes. Fire/Rescue Commission: Neumann reported issues from last Fire/Resc r�ttssib?1' g. Fire Dept. issues: purchase a 45' ladder /crane truck, possibly add on to Town Hall build' ,.,iay appro chf thers for a donation or proposal, will be receiving 25 donated SCBA units from Woodbu wt�uid li� room Town Hall to expand their space. Planning Commission: CSM's Hank Fogelberg/White Pine, Inc. requesting 4 lot CSM. M by N44*, seconded by Plourde to approve Hank Fogelberg/White Pine, Inc. 4 lot CSM. Motion carne A Lr VMb�d yes: Gary Gordon - lot r: > CSM - Motion by Schachtner, seconded by Neumann to approve Gary 1.I lot (10 .*re5)CSM . Motion carried. All members voted yes. ' 1 ' Major Subdivision: A & E Land Surveying presented map for North Bass Lake Estates 7 lot Major Subdivision. Motion by Plourde, seconded by Neumann to approve North Bass Lake Estates (Gerald Smith) 7 lot Major. Motion carried. All members voted yes. Rezone Land A & E presented Hobby Farms, Hank Fogelberg, application for rezonement from ag to ag/residential. Motion by Neumann, seconded by Schachtner to approve rezonement of 35.00 acres from ag to ag/residential for Hobby Farms -Hank Fogelberg, citing WSS 91.77. Motion carried. All members voted yes. Rezonement Hearing with County will be held Wed., April 14 at 7:00 p.m. at the Somerset Town Hall. Russ Rastetter/Traditional Woodworks requested to rezone 5.82 (+ or -) acres from ag/residential to commercial. Pierce presented Board with Conditional Use Permit packets and Rastetter's response to questions. Conditional Use Permit is ongoing until use changes or expands. Motion by Plourde, seconded by Schachtner to approve rezonement of 5.82 (+ or -) acres from ag/residential to commercial for Russ Rastetter. Motion carried. All members voted yes. Also concerning Rastetter- Motion by Neumann, seconded by Plourde to approve approximately 6,000 square foot commercial building for expanded usage of property (commercial -type building). Motion carried. All members voted yes. Discussion concerning safety at proposed intersections for new highway corridor. Pierce suggested Board pass a resolution supporting a complete interchange at Hwy. 35/64, County Road V, and Andersen Scout Camp Road. Board agreed it would be a good idea. Pierce will draft a resolution for April 13 Annual Meeting. Motion by Neumann, seconded by Plourde to pass a resolution to support a complete interchange at Hwy. 35/64, County Road V, and Andersen Scout Camp Road. Resolution will be sent to Madison. Motion carried. All members voted yes. Pierce reported Planning Commission needs a member to replace vacancy of Doug Plourde. Name(s) will be submitted next month. Pierce also asked Board if they were interested in an adult entertainment moratorium. Schachtner asked Pierce to look into it to protect Town. Summary of Twin Springs Park Agreement was presented. r Issues to be resolved involve parking. Three points presented. Board agreed to point 41 concerning putting three `No Parking" signs on the other side of the road. Board also does not object to residents cutting brush. I Now Business: Schachtner stated a letter was received recently from Bernell Jansen concerning WasteBuster's property not being zoned commercial. Jansen sent letter to County. Schachtner stated it is a County issue and Board "will send a letter to County Zoning supporting Jansen's complaint. County is supposed to be hiring an enforcement technician in April. Hopefully, some enforcement will occur. Also, Thomas Schumacher of Bakke Norman sent a letter requesting a person to person transfer of George Sinclear's liquor license to Marian Sinclear. Motion by Schachtner, seconded by Neumann to approve transfer of George Sinclear's liquor license to Marian Sinclear pursuant to WSS 125.04(12). Motion carried. All members voted yes. Neumann reported a call from Roger Miller concerning speed of vehicles on 80` Street. Neumann suggested a 'Watch Children" sign. Schachtner will see if road crew has extras or possibly take the sign down by his house and put up on 80` Street. Wittig requested clarification of area on 190` Avenue to be deeded over to responded Village. Schachtner it is the first '/4 mile East of Hwy. 35 of 190"' P Avenue. r Buildin g Permits: Michael and Patricia Hel eson- House: Board reviewed Hel eson g 's erosion control plan for house on lakefront of North Bass Lake Estates.. Pierce visited on -site. Board was satisfied with erosion control plan for Hel g eson's. County Zoning will be notified in writing that erosion control plan was satisfactory. William Bassamore- Peterson-House, Joe Gorman- House• Miles and Audrey Wittig- House; Steve Marcello- House; John House; Gary y Banttari- 'douse; Mike Ger nain -3 Houses (TI wo in Nleadowoods -One in Shadow rines); Tad Gctschei -Deck; Scott Gelle -Pole Shed; Doris Jahnke -Pole Shed; Amos Chladek- Basement addition w /entryway; Mike Lundberg- Sunroom Addition. Motion by Neumann, seconded by Plourde to approve above listed Building Permits, pending receipt of Sanitary Permits and Road Restrictions being lifted. Mike Lundberg's sunroom (no basement) was released. Mike Germain- Shadow Pines House was released due to County Road I access and 217` being a gravel road. Doris Jahnke's pole shed was released due to Hwy. 35 location. Motion carried. All members voted yes. Schachtner announced Town Board will be attending a meeting in the Village of Hammond on Thursday, April 8, at 6:00 p.m. regarding Four Feathers Casino. Annual Meeting will be held Tuesday, April 13 at 8:00 p.m. County Rezonement Hearing will be held Wednesday, April 14, at 7:00 p.m. at the Town Hall. Motion by Neumann, seconded by Plourde to adjourn. Meeting adjourned at 10:24 p.m. Jeri Koester, Clerk Helgeson Residence Site Plan on North Bass Lake (06 April 1999) 2k 23 Yom - 1 - - 'L • – - •. _ 5e jropwa to ep ou e 4 A# >Freast35= d� tretween O _ r I�Ii �– ReteRt a • Area 24 6-9 ru L —_ T _ / – – _– r � .. ~L.. 4- ­-1 _ • • • • • • • • • • • • • • • • • 100' BUILDING SETBACK (FROM R.O.W.) OO SOIL BORING E1e -1 PERC TEST NOT TO SCALE ------APPROXIMATE C PROPOSED DRIVEWAY LOCATION DENOTES 20% SLOPES OR GREATER DENOTES 12% – 20% SLOPES NEW SILT FENCE EXISTING DRAINAGE FINISHED DRAINAGE •••••••••••• LIMITS OF GRADING GRAVEL STOCKPILED SOIL „ LIMITS OF GRADING (AS NEEDED) & AREAS TO BE SEEDED, MULCHED OR EROSION CONTROL BLANKET /FABRIC Helgeson Residence Site Plan on North Bass Lake (07 April 1999) _ 23 - - 7 r T - _ -- z7 1 " `— —_ ate O r — —T -`•�. Ec i- w — _ -t - -t 24 — — — - -- . ry 9 - _ 9 isru L r r ' _ - _ — +- — • •••••••- •••••••• • 100' BUILDING SETBACK (FROM R.O.W.) OO SOIL BORING EIB —t PERC TEST 0 100 200 ------APPROXIMATE C PROPOSED DRIVEWAY LOCATION GRAPHIC SCALE DENOTES 20% SLOPES OR GREATER SCALE IN FEET. 1 inch = too feet DENOTES 12% — 20% SLOPES NEW SILT FENCE EXISTING DRAINAGE FINISHED DRAINAGE •••••••••••• LIMITS OF GRADING GRAVEL STOCKPILED SOIL LIMITS OF GRADING (AS NEEDED) & AREAS TO BE SEEDED, MULCHED OR EROSION CONTROL BLANKET /FABRIC ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A i� mil- ((� A • • Mulllrstt Arlrlri,ru, J(PI S. - lack)liai. k - ( rLcc lMIV_ 5S�c , Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number c2 1 0 LEGAL DESCRIPTION Property Locat ion ,$_ /4, " 1 /4, Sec. (L, T�N -R Town of 2 - Subdivision / \�D r 1 �C' C L'0 S , Lot # / b Certified Survey Map # 5 ( f" , Volume , Page # 4 3 Warranty Deed # 7� - 7 0 S _ , Volume '� �' L� , Page # S ec house El y es � no Lot lines identifiable N yes ❑ no Y 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 three year piration date. I OF APP IC DAft • 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 prope describ d abo e, �y virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICA DA► * * * * ** 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 .•1 ST,AT'E BAR CF Wl' ONi[N FJRNI t, r _ WARRANrY DEED > DOCI iMENT NO VIL 1 • i! 1 1 `'V+ 1 1 a I[1G t conveys an warrants to nd _4 lge?j iZ�+ _Helg on aDd lJatricl0 AJx MAR 1 0 1998 b� e__son husband_ � wife _ - - - A .� -_ -- -- ___-_. 9.30 —~-- — - -i — rHiS S.'ACE lEfif ?QED FOR RECGRDiNG )AtA 1 NAbti AND RETURN ADDRESS the f,UowinK described real estate in St CrO1X — ;" State of Wixonsin: -- 42U I A32-2107-60 Lot 16, NOrth Pass Lake Estates. 1 �. TRANSFER N , FE ".; This 1S_ nOt homesteat! nmprrty t is tu,ii Exception to ,car nt.r4 Easeme,��s, restrictions and rights -of -way of record, if any, Dated ;his, .i day of _ -- -- __11dLCfL —_ A u � . ; -- — - SEA - -- By" president — -- - - -- ('EALI . - - -- -- — - -- - - -- - - - - - -- (SEAL AUTHENTICATION" E� ACKNOWLEDGMENT GeraUsi _SMj t1? _ —_ State of Wisconsin, ' atl0wilticai-_; u.. da y of !xfure me his _ dal of s 16s L — y _ the above namca iAtLR -„ AI'E BAR Ur W t authom_ed by 37Oh 0(j, %%'is. xat, a , ;,, he the Ik .,,n _ ch �iiut – , rid mil ..: h:li)u l d e l he -at. 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